diff --git a/lib/conflicts/conflicts/agents/doctor_agent.py b/lib/conflicts/conflicts/agents/doctor_agent.py
index c7c5ca1..d1aff8f 100644
--- a/lib/conflicts/conflicts/agents/doctor_agent.py
+++ b/lib/conflicts/conflicts/agents/doctor_agent.py
@@ -3,7 +3,7 @@
from typing import Any, Dict
from ..core.base import BaseAgent
-from ..core.models import ConflictResult, DocumentPair, PropositionResult
+from ..core.models import ConflictPair, ConflictResult, DocumentPair, PropositionResult
from ..core.temporal_analysis import TemporalAnalyzer
prompts_dir = Path(__file__).parent.parent.parent / "prompts"
@@ -100,29 +100,50 @@ def __call__(
parsed_response = self._parse_json_response(response)
# Validate required fields
- required_fields = ["conflict_type", "reasoning", "modification_instructions"]
- for field in required_fields:
- if field not in parsed_response:
- raise ValueError(f"Missing required field '{field}' in Doctor Agent response")
-
- # Validate conflict type exists
- if parsed_response["conflict_type"] not in self.conflict_types:
- self.logger.warning(
- f"Unknown conflict type '{parsed_response['conflict_type']}', \
- defaulting to 'opposition'"
+ if "conflict_pairs" not in parsed_response:
+ raise ValueError("Missing required field 'conflict_pairs' in Doctor Agent response")
+
+ conflict_pairs = []
+ for pair_data in parsed_response["conflict_pairs"]:
+ # Validate required fields for each conflict pair
+ required_fields = ["conflict_type", "reasoning", "modification_instructions"]
+ for field in required_fields:
+ if field not in pair_data:
+ self.logger.warning(
+ f"Skipping conflict pair due to missing required field '{field}'"
+ )
+ continue
+
+ # Validate conflict type exists
+ if pair_data["conflict_type"] not in self.conflict_types:
+ self.logger.warning(
+ f"Skipping invalid conflict type '{pair_data['conflict_type']}'. "
+ f"Valid types: {list(self.conflict_types.keys())}"
+ )
+ continue
+
+ conflict_pair = ConflictPair(
+ conflict_type=pair_data["conflict_type"],
+ reasoning=pair_data["reasoning"],
+ modification_instructions=pair_data["modification_instructions"],
+ editor_instructions=pair_data.get("editor_instructions", []),
+ proposition_conflicts=pair_data.get("proposition_conflicts", []),
)
- parsed_response["conflict_type"] = "opposition"
-
- result = ConflictResult(
- conflict_type=parsed_response["conflict_type"],
- reasoning=parsed_response["reasoning"],
- modification_instructions=parsed_response["modification_instructions"],
- editor_instructions=parsed_response.get("editor_instructions", []),
- proposition_conflicts=parsed_response.get("proposition_conflicts", []),
- )
+ conflict_pairs.append(conflict_pair)
+
+ # Check if we have any valid conflict pairs
+ if not conflict_pairs:
+ raise ValueError(
+ "No valid conflict pairs found in Doctor Agent response. "
+ "All conflict pairs were skipped due to validation errors."
+ )
+
+ result = ConflictResult(conflict_pairs=conflict_pairs)
self.logger.info("Doctor Agent completed analysis")
- self.logger.info(f"Selected conflict type: {result.conflict_type}")
+ self.logger.info(f"Selected {len(result.conflict_pairs)} conflict pairs")
+ for pair in result.conflict_pairs:
+ self.logger.info(f" - {pair.conflict_type}: {pair.reasoning[:100]}...")
self.logger.info(
f"Temporal context: {temporal_analysis.get('time_context', 'Unknown')}"
)
diff --git a/lib/conflicts/conflicts/agents/editor_agent.py b/lib/conflicts/conflicts/agents/editor_agent.py
index 71ebd98..3d06d9a 100644
--- a/lib/conflicts/conflicts/agents/editor_agent.py
+++ b/lib/conflicts/conflicts/agents/editor_agent.py
@@ -2,7 +2,7 @@
from ..core.base import BaseAgent
from ..core.document_operations import parse_response
-from ..core.models import ConflictResult, DocumentPair, EditorResult
+from ..core.models import ConflictPair, DocumentPair, EditorResult
prompts_dir = Path(__file__).parent.parent.parent / "prompts"
EDITOR_SYSTEM_PROMPT_PATH = prompts_dir / "editor_agent_system.txt"
@@ -21,7 +21,7 @@ def __init__(self, client, model, cfg):
self.min_text_length = cfg.editor.min_text_length
def __call__(
- self, document_pair: DocumentPair, conflict_instructions: ConflictResult
+ self, document_pair: DocumentPair, conflict_instructions: ConflictPair
) -> EditorResult:
"""
Modify documents to introduce the specified conflict
@@ -54,7 +54,7 @@ def __call__(
self.logger.warning(f"Attempt {attempt + 1} failed: {e}, retrying...")
def _perform_modification(
- self, document_pair: DocumentPair, conflict_instructions: ConflictResult
+ self, document_pair: DocumentPair, conflict_instructions: ConflictPair
) -> EditorResult:
"""Perform a single modification attempt"""
prompt = self._build_prompt(document_pair, conflict_instructions)
@@ -63,7 +63,7 @@ def _perform_modification(
return self._create_result(parsed_result, document_pair)
def _build_prompt(
- self, document_pair: DocumentPair, conflict_instructions: ConflictResult
+ self, document_pair: DocumentPair, conflict_instructions: ConflictPair
) -> str:
"""Build the prompt for modification"""
# Extract specific propositions for each document
diff --git a/lib/conflicts/conflicts/core/base.py b/lib/conflicts/conflicts/core/base.py
index 156b73c..fe40fd1 100644
--- a/lib/conflicts/conflicts/core/base.py
+++ b/lib/conflicts/conflicts/core/base.py
@@ -46,6 +46,9 @@ class DocumentData:
timestamp_1: Optional[str]
timestamp_2: Optional[str]
created_at: Optional[str]
+ moderator_score: Optional[int] = None
+ moderator_reasoning: Optional[str] = None
+ conflict_type: Optional[str] = None
@dataclass
@@ -185,6 +188,9 @@ def save_validated_documents(
created_at=datetime.now().isoformat(),
timestamp_1=str(original_pair.doc1_timestamp) if original_pair.doc1_timestamp else None,
timestamp_2=str(original_pair.doc2_timestamp) if original_pair.doc2_timestamp else None,
+ moderator_score=validation_result.score,
+ moderator_reasoning=validation_result.reasoning,
+ conflict_type=conflict_type,
)
# Create annotations list
diff --git a/lib/conflicts/conflicts/core/models.py b/lib/conflicts/conflicts/core/models.py
index a618582..1fbd6c5 100644
--- a/lib/conflicts/conflicts/core/models.py
+++ b/lib/conflicts/conflicts/core/models.py
@@ -19,8 +19,8 @@ class DocumentPair:
@dataclass
-class ConflictResult:
- """Result from the Doctor Agent"""
+class ConflictPair:
+ """Represents a single conflict pair for a specific conflict type"""
conflict_type: str
reasoning: str
@@ -29,6 +29,13 @@ class ConflictResult:
proposition_conflicts: Optional[list[dict]] = None
+@dataclass
+class ConflictResult:
+ """Result from the Doctor Agent - now contains multiple conflict pairs"""
+
+ conflict_pairs: list[ConflictPair]
+
+
@dataclass
class EditorResult:
"""Result from the Editor Agent"""
diff --git a/lib/conflicts/conflicts/core/pipeline.py b/lib/conflicts/conflicts/core/pipeline.py
index 4dc720b..510a5d6 100644
--- a/lib/conflicts/conflicts/core/pipeline.py
+++ b/lib/conflicts/conflicts/core/pipeline.py
@@ -134,16 +134,15 @@ def process_document_pair(self, document_pair: DocumentPair) -> Tuple[bool, Dict
result_data = {
"pair_id": pair_id,
"success": False,
- "conflict_type": None,
+ "conflict_pairs": 0,
+ "successful_pairs": 0,
+ "total_pairs": 0,
"processing_time": 0,
"proposition_result": None,
"doctor_result": None,
- "editor_result": None,
- "moderator_result": None,
+ "conflict_pair_results": [],
"proposition_time": 0,
"doctor_time": 0,
- "editor_time": 0,
- "moderator_time": 0,
}
# Step 1: Proposition Agent decomposes documents into propositions
@@ -155,78 +154,111 @@ def process_document_pair(self, document_pair: DocumentPair) -> Tuple[bool, Dict
result_data["proposition_result"] = proposition_result
result_data["proposition_time"] = proposition_time
- # Step 2: Doctor Agent identifies conflict type using propositions
-
+ # Step 2: Doctor Agent identifies conflict pairs using propositions
conflict_result, doctor_time = self._execute_agent(
self.doctor_agent, document_pair, proposition_result[0], proposition_result[1]
)
result_data["doctor_result"] = conflict_result
result_data["doctor_time"] = doctor_time
- result_data["conflict_type"] = conflict_result.conflict_type
+ result_data["conflict_pairs"] = len(conflict_result.conflict_pairs)
- # Step 3: Editor and Moderator agents with retry logic for editor only
- validation_result = None
- editor_result = None
+ # Step 3: Process each conflict pair through Editor and Moderator agents
+ all_results = []
+ successful_pairs = 0
- for attempt in range(1, self.max_retries + 1):
- # Execute editor agent
- editor_result, editor_time = self._execute_agent(
- self.editor_agent, document_pair, conflict_result
+ for i, conflict_pair in enumerate(conflict_result.conflict_pairs):
+ self.logger.info(
+ f"Processing conflict pair {i+1}/{len(conflict_result.conflict_pairs)}:"
+ f" {conflict_pair.conflict_type}"
)
- result_data["editor_result"] = editor_result
- result_data["editor_time"] = editor_time
- # Check if editor agent failed to create modifications
- if "Failed to create conflict" in editor_result.changes_made:
- self.logger.warning(
- "Editor agent failed to create modifications, skipping moderator validation"
+ pair_result = {
+ "conflict_type": conflict_pair.conflict_type,
+ "success": False,
+ "editor_result": None,
+ "moderator_result": None,
+ "editor_time": 0,
+ "moderator_time": 0,
+ "attempts": 0,
+ }
+
+ validation_result = None
+ editor_result = None
+
+ for attempt in range(1, self.max_retries + 1):
+ pair_result["attempts"] = attempt
+
+ # Execute editor agent
+ editor_result, editor_time = self._execute_agent(
+ self.editor_agent, document_pair, conflict_pair
)
- validation_result = ValidationResult(
- is_valid=False,
- score=1,
- reasoning="Editor agent failed to modify - no changes to validate",
+ pair_result["editor_result"] = editor_result
+ pair_result["editor_time"] = editor_time
+
+ # Check if editor agent failed to create modifications
+ if "Failed to create conflict" in editor_result.changes_made:
+ self.logger.warning(
+ f"Editor agent failed to create modifications for "
+ f"{conflict_pair.conflict_type}, skipping moderator validation"
+ )
+ validation_result = ValidationResult(
+ is_valid=False,
+ score=1,
+ reasoning="Editor agent failed to modify - no changes to validate",
+ )
+ pair_result["moderator_result"] = validation_result
+ pair_result["moderator_time"] = 0
+ break
+
+ # Execute moderator agent for validation
+ validation_result, moderator_time = self._execute_agent(
+ self.moderator_agent, document_pair, editor_result, conflict_pair.conflict_type
)
- result_data["moderator_result"] = validation_result
- result_data["moderator_time"] = 0
- break
+ pair_result["moderator_result"] = validation_result
+ pair_result["moderator_time"] = moderator_time
- # Execute moderator agent for validation
- validation_result, moderator_time = self._execute_agent(
- self.moderator_agent, document_pair, editor_result, conflict_result.conflict_type
- )
- result_data["moderator_result"] = validation_result
- result_data["moderator_time"] = moderator_time
+ self.logger.info(
+ f"Attempt {attempt}: {conflict_pair.conflict_type} conflict, "
+ f"valid={validation_result.is_valid}, score={validation_result.score}/5"
+ )
- self.logger.info(
- f"Attempt {attempt}: {conflict_result.conflict_type} conflict, "
- f"valid={validation_result.is_valid}, score={validation_result.score}/5"
- )
+ if validation_result.is_valid:
+ pair_result["success"] = True
+ successful_pairs += 1
+ break
+
+ if attempt < self.max_retries:
+ self.logger.warning(
+ f"Validation failed for {conflict_pair.conflict_type}, retrying..."
+ )
+ time.sleep(1)
+
+ # Save to database if validation passed
+ if validation_result and validation_result.is_valid:
+ is_success = self._save_to_database(
+ f"{pair_id}_{conflict_pair.conflict_type}",
+ document_pair,
+ editor_result,
+ conflict_pair.conflict_type,
+ validation_result,
+ )
+ pair_result["success"] = is_success
- if validation_result.is_valid:
- result_data["success"] = True
- break
-
- if attempt < self.max_retries:
- self.logger.warning("Validation failed, retrying...")
- time.sleep(1)
-
- # Step 3: Save to database if validation passed
- if validation_result and validation_result.is_valid:
- is_success = self._save_to_database(
- pair_id,
- document_pair,
- editor_result,
- conflict_result.conflict_type,
- validation_result,
- )
- result_data["success"] = is_success
+ all_results.append(pair_result)
+
+ # Update result data with all conflict pair results
+ result_data["conflict_pair_results"] = all_results
+ result_data["successful_pairs"] = successful_pairs
+ result_data["total_pairs"] = len(conflict_result.conflict_pairs)
+ result_data["success"] = successful_pairs > 0 # Success if at least one pair succeeded
result_data["processing_time"] = time.time() - start_time
# Summary log
status = "SUCCESS" if result_data["success"] else "FAILED"
self.logger.info(
- f"Pair {pair_id}: {status} - {conflict_result.conflict_type} conflict, "
+ f"{pair_id}: {status} - {result_data['successful_pairs']}/{result_data['total_pairs']} "
+ "conflict pairs successful, "
f"{proposition_result[0].total_propositions + proposition_result[1].total_propositions}"
f" propositions"
)
@@ -272,16 +304,15 @@ def execute(
failed_result = {
"pair_id": f"{doc_pair.doc1_id}_{doc_pair.doc2_id}",
"success": False,
- "conflict_type": None,
+ "conflict_pairs": 0,
+ "successful_pairs": 0,
+ "total_pairs": 0,
"processing_time": 0,
"proposition_result": None,
"doctor_result": None,
- "editor_result": None,
- "moderator_result": None,
+ "conflict_pair_results": [],
"proposition_time": 0,
"doctor_time": 0,
- "editor_time": 0,
- "moderator_time": 0,
"error": str(e),
}
results.append(failed_result)
diff --git a/lib/conflicts/label-studio.xml b/lib/conflicts/label-studio.xml
index 1bdeb5b..0c81758 100644
--- a/lib/conflicts/label-studio.xml
+++ b/lib/conflicts/label-studio.xml
@@ -17,15 +17,64 @@
-
-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
-
-
-
-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
diff --git a/lib/conflicts/processed/_18092025.json b/lib/conflicts/processed/_18092025.json
new file mode 100644
index 0000000..a9bc02f
--- /dev/null
+++ b/lib/conflicts/processed/_18092025.json
@@ -0,0 +1,2067 @@
+[
+ {
+ "data": {
+ "doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 79% on room air\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "orig_doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "orig_doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "timestamp_1": "2125-04-16 07:23:00",
+ "timestamp_2": "2125-04-08 15:15:00",
+ "created_at": "2025-09-18T10:35:03.772140"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present a plausible temporal mismatch: Document 1 records a single SpO₂ of 79 % on room air, while Document 2 notes an admission reading of 93 % on a non‑rebreather and a later 79 % on room air, which can coexist if taken at different moments. This respects physiological plausibility for an ILD patient and fits the clinical chain (hypoxia → escalation of O₂). However, the second “conflict” merely repeats the same text, offering no real contradiction, which weakens the overall conflict quality. The overall reconciliation is realistic but the conflict creation is only partially effective. \n\nScore: 4",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 1229,
+ "end": 1250,
+ "text": "SpO2: 79% on room air",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present a plausible temporal mismatch: Document 1 records a single SpO₂ of 79 % on room air, while Document 2 notes an admission reading of 93 % on a non‑rebreather and a later 79 % on room air, which can coexist if taken at different moments. This respects physiological plausibility for an ILD patient and fits the clinical chain (hypoxia → escalation of O₂). However, the second “conflict” merely repeats the same text, offering no real contradiction, which weakens the overall conflict quality. The overall reconciliation is realistic but the conflict creation is only partially effective. \n\nScore: 4",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 982,
+ "end": 1037,
+ "text": "Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: sinus rhythm without ventricular pacing\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, no pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "orig_doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "orig_doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "timestamp_1": "2125-04-16 07:23:00",
+ "timestamp_2": "2125-04-08 15:15:00",
+ "created_at": "2025-09-18T10:35:07.438174"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two notes present a direct contradiction about cardiac rhythm: Document 1 now states a sinus rhythm without ventricular pacing, while Document 2 asserts an “old V‑paced” rhythm yet also claims the patient has **no pacemaker**. Temporal compatibility is weak (both refer to the same admission period), semantic normalization shows mismatched terminology (“sinus rhythm” vs. “V‑paced”), physiological plausibility is low because a V‑paced rhythm cannot occur without a device, and the clinical chain (management decisions based on pacing status) is inconsistent. Such a stark, realistic documentation error makes the conflict plausible yet clearly unresolved, reflecting good conflict‑creation quality. \n\nScore: 5",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 1242,
+ "end": 1295,
+ "text": "Heart rhythm: sinus rhythm without ventricular pacing",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two notes present a direct contradiction about cardiac rhythm: Document 1 now states a sinus rhythm without ventricular pacing, while Document 2 asserts an “old V‑paced” rhythm yet also claims the patient has **no pacemaker**. Temporal compatibility is weak (both refer to the same admission period), semantic normalization shows mismatched terminology (“sinus rhythm” vs. “V‑paced”), physiological plausibility is low because a V‑paced rhythm cannot occur without a device, and the clinical chain (management decisions based on pacing status) is inconsistent. Such a stark, realistic documentation error makes the conflict plausible yet clearly unresolved, reflecting good conflict‑creation quality. \n\nScore: 5",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 92,
+ "end": 104,
+ "text": "no pacemaker",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 80/40(53) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "orig_doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "orig_doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "timestamp_1": "2125-04-16 07:23:00",
+ "timestamp_2": "2125-04-08 15:15:00",
+ "created_at": "2025-09-18T10:35:22.476198"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same 79‑year‑old patient but report markedly different blood‑pressure values. Document 1 (flow‑sheet) now shows a hypotensive 80/40 mmHg reading, whereas Document 2 (transfer vitals) records a normotensive 155/76 mmHg. Temporally the measurements could belong to different phases (pre‑transfer vs. post‑transfer), making the discrepancy plausible if the patient’s hemodynamics improved after interventions (e.g., fluids, vasopressors). Physiologically, both values are within possible ranges for a CHF/ILD patient. Semantically the values are normalized (systolic/diastolic). The conflict is realistic because it reflects a clinically believable change, though the second “conflict” actually repeats the same text, offering no additional tension. Overall the conflict is coherent, plausible, and reconcilable, but the lack of a genuine alteration in conflict_2 prevents a perfect rating.\n\n**Score: 4**",
+ "conflict_type": "value",
+ "value": {
+ "start": 1152,
+ "end": 1195,
+ "text": "BP: 80/40(53) {83/47(62) - 129/73(85)} mmHg",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same 79‑year‑old patient but report markedly different blood‑pressure values. Document 1 (flow‑sheet) now shows a hypotensive 80/40 mmHg reading, whereas Document 2 (transfer vitals) records a normotensive 155/76 mmHg. Temporally the measurements could belong to different phases (pre‑transfer vs. post‑transfer), making the discrepancy plausible if the patient’s hemodynamics improved after interventions (e.g., fluids, vasopressors). Physiologically, both values are within possible ranges for a CHF/ILD patient. Semantically the values are normalized (systolic/diastolic). The conflict is realistic because it reflects a clinically believable change, though the second “conflict” actually repeats the same text, offering no additional tension. Overall the conflict is coherent, plausible, and reconcilable, but the lack of a genuine alteration in conflict_2 prevents a perfect rating.\n\n**Score: 4**",
+ "conflict_type": "value",
+ "value": {
+ "start": 1041,
+ "end": 1109,
+ "text": "Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 95 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "orig_doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "orig_doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "timestamp_1": "2125-04-16 07:23:00",
+ "timestamp_2": "2125-04-08 15:15:00",
+ "created_at": "2025-09-18T10:36:26.309128"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe HR change in Document 1 (from a plausible 60 bpm to 95 bpm) creates a measurable discrepancy with Document 2, which records an admission HR of 72 bpm and later a paced rate in the 70s. The timing aligns: Document 1’s flow‑sheet is several hours after admission, so a rise to 95 bpm is physiologically plausible (e.g., stress, hypoxia, medication). Semantic normalization is straightforward (numeric HR values). The clinical chain (hypoxia → sympathetic drive → tachycardia) supports the shift, and a realistic reconciliation (HR decreased later when paced) is feasible. Conflict 2 makes no actual change, so it does not affect realism. Overall, the conflict is coherent, plausible, and well‑structured.\n\n**Score: 5**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 1128,
+ "end": 1148,
+ "text": "HR: 95 (60 - 62) bpm",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe HR change in Document 1 (from a plausible 60 bpm to 95 bpm) creates a measurable discrepancy with Document 2, which records an admission HR of 72 bpm and later a paced rate in the 70s. The timing aligns: Document 1’s flow‑sheet is several hours after admission, so a rise to 95 bpm is physiologically plausible (e.g., stress, hypoxia, medication). Semantic normalization is straightforward (numeric HR values). The clinical chain (hypoxia → sympathetic drive → tachycardia) supports the shift, and a realistic reconciliation (HR decreased later when paced) is feasible. Conflict 2 makes no actual change, so it does not affect realism. Overall, the conflict is coherent, plausible, and well‑structured.\n\n**Score: 5**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 982,
+ "end": 1037,
+ "text": "Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems now includes new crackles heard bilaterally on lung auscultation.\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "orig_doc_1": "TITLE:\n Chief Complaint: Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA,\n RA associated ILD, atrial flutter, CHF, and dementia admitted for\n hypoxia.\n 24 Hour Events:\n - Gerimed recs- continue haldol, add APAP 1000mg TID standing, standing\n colace/senna and dulcolax po prn.\n - Spoke with son [**Name (NI) 7075**] ([**Telephone/Fax (1) 7608**], will get palliative care c/s\n in AM\n Allergies:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Haloperidol (Haldol) - [**2125-4-15**] 09:30 AM\n Heparin Sodium (Prophylaxis) - [**2125-4-15**] 06:30 PM\n Other medications:\n Changes to medical and family history:\n Review of systems is unchanged from admission except as noted below\n Review of systems:\n Flowsheet Data as of [**2125-4-16**] 07:23 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since 12 AM\n Tmax: 36.9\nC (98.4\n Tcurrent: 36.9\nC (98.4\n HR: 60 (60 - 62) bpm\n BP: 126/59(74) {83/47(62) - 129/73(85)} mmHg\n RR: 17 (14 - 25) insp/min\n SpO2: 93%\n Heart rhythm: V Paced\n Wgt (current): 84.5 kg (admission): 83.8 kg\n Height: 68 Inch\n Total In:\n 800 mL\n PO:\n 720 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 333 mL\n 220 mL\n Urine:\n 333 mL\n 220 mL\n NG:\n Stool:\n Drains:\n Balance:\n 467 mL\n -220 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SpO2: 93%\n ABG: ////\n Physical Examination\n Peripheral Vascular: (Right radial pulse: Not assessed), (Left radial\n pulse: Not assessed), (Right DP pulse: Not assessed), (Left DP pulse:\n Not assessed)\n Skin: Not assessed\n Neurologic: Responds to: Not assessed, Movement: Not assessed, Tone:\n Not assessed\n Labs / Radiology\n 307 K/uL\n 11.1 g/dL\n 97 mg/dL\n 0.8 mg/dL\n 32 mEq/L\n 3.6 mEq/L\n 27 mg/dL\n 101 mEq/L\n 143 mEq/L\n 33.1 %\n 7.8 K/uL\n [image002.jpg]\n [**2125-4-7**] 03:24 PM\n [**2125-4-8**] 03:37 AM\n [**2125-4-10**] 04:45 AM\n [**2125-4-12**] 03:11 AM\n [**2125-4-12**] 05:03 PM\n [**2125-4-13**] 03:14 AM\n [**2125-4-15**] 02:06 AM\n WBC\n 9.3\n 6.5\n 9.6\n 9.1\n 7.8\n Hct\n 27.3\n 32.2\n 29.9\n 31.7\n 31.5\n 33.1\n Plt\n 275\n 311\n 295\n 324\n 307\n Cr\n 0.9\n 0.9\n 0.7\n 1.0\n 0.9\n 0.9\n 0.8\n TropT\n <0.01\n Glucose\n 117\n 99\n 102\n 97\n 92\n 97\n Other labs: PT / PTT / INR:14.0/26.8/1.2, CK / CKMB /\n Troponin-T:21//<0.01, ALT / AST:[**4-16**], Alk Phos / T Bili:85/0.4,\n Differential-Neuts:89.9 %, Lymph:6.5 %, Mono:2.8 %, Eos:0.6 %,\n Albumin:3.0 g/dL, LDH:299 IU/L, Ca++:9.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.9\n mg/dL\n Assessment and Plan\n Mrs. [**Known lastname 7548**] is a 79 year old female with a his of RA, RA associated\n ILD, atrial flutter, CHF, and dementia admitted for hypoxia.\n # Hypoxia: Current hypoxia secondary to end-stage RA-associated ILD.\n Patient appears euvolemic on exam today.\n - Wean supplemental oxygen with goal SaO2 >90%\n - Convert to maintenance po lasix with goal TBB even\n - Hold on increasing steroid dose or cytotoxic therapy\n - Attempt to contact son.\n - Continue afterload reduction with captopril\n # Agitation: Per [**Female First Name (un) **]-med, risperdal held and restarted haldol with\n marked improved in agitation.\n - Continue haldol qhs and prn\n - Follow-up with [**Female First Name (un) **]-med recs if any\n - Check ECG\n # RA\n - Continue prednisone and plaquenil\n # Atrial flutter: Rate decreased to increase LV filling time two days\n ago. Patient continues to be paced.\n # Hypothyroidism\n - Continue Levothyroxine, convert to PO.\n # Spinal Stenosis\n - Hold Oxycodone for now to prevent exacerbation of respiratory\n failure\n FEN: Thin liquids and ground solids with 1:1 supervision per S+S.\n Replete as necessary.\n PPx: Heparin SQ\n Code: DNR/DNI\n Contact: [**Name (NI) **] [**Name (NI) 7075**] [**Telephone/Fax (1) 7493**]\n [**Name2 (NI) **]o: ICU level of care\n ICU Care\n Nutrition:\n Glycemic Control:\n Lines:\n 22 Gauge - [**2125-4-11**] 02:26 AM\n Prophylaxis:\n DVT: SQ UF Heparin\n Stress ulcer: PPI\n VAP:\n Comments:\n Communication: Comments:\n Code status: DNR / DNI\n Disposition:\n",
+ "orig_doc_2": "HPI:\n This is a 79 yo F h/o ILD (normal O2 sat at baseline), RA, atrial\n flutter, CHF, pacemaker, dementia admitted for hypoxia. Per call-in to\n ED, the patient fell yesterday; X-ray pelvic and lower back\n unremarkable. Then this morning at 4am, was found to be 79% on RA,\n improved to mid-90's on NRB. Per [**Hospital 328**] Rehab, the patient was not in\n distress or tachypnic. The patient herself is unable to answer\n questions reliably but denies pain or CP.\n .\n In the ED: The patient arrived hypoxic to 84 on ra and 88 on 4 L NC, 94\n on NRB. The patient was not tachypnic or in distress. CXR showed\n pulmonary edema; PE demonstrated crackles [**1-2**] way up lung fields\n bilaterally. BNP elevated to 3284. Trop neg. EKG with old Vpaced at 70,\n neg Sgarbossa's critera. She was placed on Bipap 10/5, nitro gtt and\n lasix 20mg IV. She put out 650ml. Cardiology was called for admission\n to the CCU but refused the admission as pt has hx ILD.\n Vitals on admission: temp97.1 HR72 Bp134/73 RR24 93%NRB\n Vitals on transfer: Vpaced 70's LBBB afebrile 155/76 18 94% on BiPAp\n Pt had ct of chest this afternoon, and plans to have and echo\n .H/O heart failure (CHF), Diastolic, Acute on Chronic\n Assessment:\n Pt has crackles half up bilaterally, sats 89-91% on 5liters\n Action:\n pt given lasix 80 po this am, also had chest ct this afternoon\n Response:\n Pt put out 460 of urine from lasix\n Plan:\n Chest ct done this afternoon showing interstitial lung disease r/t ra,\n they feel now this is more the issue then chf, it on ra med and\n steroids, will need echo done\n .H/O dementia (including Alzheimer's, Multi Infarct)\n Assessment:\n Pt still has periods of confusion, but can be agitated and combative\n at time although I have had no issues this am, has poor shot term\n memory\n Action:\n Pt reoriented, pt oob to chair,\n Response:\n Did well with direction, keeping directions simple\n Plan:\n Using least restrictive measures, encourage as much independence as\n possible with in reason of illness,\n Would keep pt within view of nursing station, side rails x4,\n Fall(s)\n Assessment:\n Pt at high risk for falls had fallen the day before her admission\n Action:\n Pt within view of desk, bed in low position, pt reoriented\n Response:\n Pt has been manageable, today oob to chair x4 hrs did well, with\n assistance\n Plan:\n Pt will continue to have 4 side rails, bed low and locked, pt\n reoriented as needed\n Demographics\n Attending MD:\n [**Location (un) **] [**Doctor First Name **] A.\n Admit diagnosis:\n CONGESTIVE HEART FAILURE\n Code status:\n DNR / DNI\n Height:\n 68 Inch\n Admission weight:\n 83.8 kg\n Daily weight:\n Allergies/Reactions:\n Verapamil\n Unknown;\n Nsaids\n Unknown;\n Precautions:\n PMH: Anemia\n CV-PMH: CHF, Pacemaker\n Additional history: demetia. interstical lung disease, orientated to\n person only\n Surgery / Procedure and date:\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:136\n D:71\n Temperature:\n 97\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 23 insp/min\n Heart Rate:\n 80 bpm\n Heart rhythm:\n V Paced\n O2 delivery device:\n Face tent\n O2 saturation:\n 92% %\n O2 flow:\n 12 L/min\n FiO2 set:\n 70% %\n 24h total in:\n 896 mL\n 24h total out:\n 1,110 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2125-4-8**] 03:37 AM\n Potassium:\n 3.7 mEq/L\n [**2125-4-8**] 03:37 AM\n Chloride:\n 102 mEq/L\n [**2125-4-8**] 03:37 AM\n CO2:\n 27 mEq/L\n [**2125-4-8**] 03:37 AM\n BUN:\n 25 mg/dL\n [**2125-4-8**] 03:37 AM\n Creatinine:\n 0.9 mg/dL\n [**2125-4-8**] 03:37 AM\n Glucose:\n 99 mg/dL\n [**2125-4-8**] 03:37 AM\n Hematocrit:\n 27.3 %\n [**2125-4-8**] 03:37 AM\n Finger Stick Glucose:\n 114\n [**2125-4-8**] 04:00 AM\n Valuables / Signature\n Patient valuables: clothes with patient\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: micu 7\n Transferred to: cc727\n Date & time of Transfer: [**2122-4-8**] 1600\n",
+ "timestamp_1": "2125-04-16 07:23:00",
+ "timestamp_2": "2125-04-08 15:15:00",
+ "created_at": "2025-09-18T10:36:34.720274"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same 79‑year‑old patient with ILD, RA, CHF, and dementia. Doc 1’s conflict introduces “new crackles” on the current ROS, implying they were absent on admission. Doc 2’s HPI already notes crackles on presentation (“crackles 1‑2 way up lung fields bilaterally”). This creates a temporal incompatibility: the finding cannot be both present on admission and newly discovered later without an explicit progression narrative. All other semantic elements (patient age, comorbidities, hypoxia) align, making the conflict realistic and clinically plausible if interpreted as worsening pulmonary edema. The modification is clear, medically coherent, and allows a realistic reconciliation (e.g., crackles worsened). \n\n**Score: 5**",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 729,
+ "end": 812,
+ "text": "Review of systems now includes new crackles heard bilaterally on lung auscultation.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same 79‑year‑old patient with ILD, RA, CHF, and dementia. Doc 1’s conflict introduces “new crackles” on the current ROS, implying they were absent on admission. Doc 2’s HPI already notes crackles on presentation (“crackles 1‑2 way up lung fields bilaterally”). This creates a temporal incompatibility: the finding cannot be both present on admission and newly discovered later without an explicit progression narrative. All other semantic elements (patient age, comorbidities, hypoxia) align, making the conflict realistic and clinically plausible if interpreted as worsening pulmonary edema. The modification is clear, medically coherent, and allows a realistic reconciliation (e.g., crackles worsened). \n\n**Score: 5**",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 0,
+ "end": 4,
+ "text": "HPI:",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. The patient is alert and able to speak clearly, and has discussed rehabilitation needs with the team. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "orig_doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "orig_doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "timestamp_1": "2182-05-07 15:01:00",
+ "timestamp_2": "2182-05-07 12:24:00",
+ "created_at": "2025-09-18T10:36:52.993477"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two notes present a direct contradiction: Document 1 records “Unable to speak with patient,” while Document 2 states the patient “is alert and able to speak clearly.” Temporal compatibility is plausible because the nutrition note likely precedes the discharge‑planning note, allowing for clinical improvement after tracheostomy and aspiration pneumonia. Semantic normalization shows both sentences refer to the same functional ability (speech). Physiologically, a post‑trach patient can progress from non‑communicative to speaking as airway edema resolves. Clinically, the chain (initial inability → later ability) fits typical recovery trajectories. A realistic reconciliation would note the change in status over time, making the conflict both acceptable and believable.\n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 15,
+ "end": 159,
+ "text": "Case reviewed w/ team, pt will need rehab. The patient is alert and able to speak clearly, and has discussed rehabilitation needs with the team.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.Physical exam noted a flat, non‑distended abdomen with no tenderness.\n",
+ "orig_doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "orig_doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "timestamp_1": "2182-05-07 15:01:00",
+ "timestamp_2": "2182-05-07 12:24:00",
+ "created_at": "2025-09-18T10:37:01.839064"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents describe opposite abdominal findings at the same care episode: Document 1 records a “soft/ distended” abdomen with positive bowel sounds, while Document 2 inserts a “flat, non‑distended abdomen with no tenderness.” Temporally the notes appear to refer to the same day, making the discrepancy immediate. Semantic normalization shows direct opposites (distended vs non‑distended, presence vs absence of tenderness). Physiologically a patient cannot simultaneously have a distended and a flat abdomen, so the conflict is plausible only if the exams were taken at different times or by different observers. Clinically the chain is believable because bedside assessments can vary, especially in a post‑transplant, ventilated patient. A realistic reconciliation would note the change in abdominal status over time or attribute it to inter‑rater variation, which the conflict allows. Overall the conflict is clear, realistic, and well‑constructed.\n\nScore: 5",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 1642,
+ "end": 1699,
+ "text": "GI: Abdomen soft/ distended/ positive bowel sounds/flatus",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents describe opposite abdominal findings at the same care episode: Document 1 records a “soft/ distended” abdomen with positive bowel sounds, while Document 2 inserts a “flat, non‑distended abdomen with no tenderness.” Temporally the notes appear to refer to the same day, making the discrepancy immediate. Semantic normalization shows direct opposites (distended vs non‑distended, presence vs absence of tenderness). Physiologically a patient cannot simultaneously have a distended and a flat abdomen, so the conflict is plausible only if the exams were taken at different times or by different observers. Clinically the chain is believable because bedside assessments can vary, especially in a post‑transplant, ventilated patient. A realistic reconciliation would note the change in abdominal status over time or attribute it to inter‑rater variation, which the conflict allows. Overall the conflict is clear, realistic, and well‑constructed.\n\nScore: 5",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 153,
+ "end": 237,
+ "text": "CM will follow.Physical exam noted a flat, non‑distended abdomen with no tenderness.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for ptPoint‑of‑care glucose measured at 80 mg/dL during the discharge planning visit.\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "orig_doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "orig_doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "timestamp_1": "2182-05-07 15:01:00",
+ "timestamp_2": "2182-05-07 12:24:00",
+ "created_at": "2025-09-18T10:37:10.549289"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present contradictory glucose values: the first shows severe hyperglycemia (334 mg/dL, 312 mg/dL) on 5/7, while the second inserts a point‑of‑care reading of 80 mg/dL during discharge planning. The units are consistent, and the dates suggest the discharge reading could be later, making temporal compatibility plausible. Physiologically, glucose can fall from >300 to ~80 mg/dL with aggressive insulin or changes in nutrition, especially after tube‑feed adjustments, so the discrepancy is not impossible. Clinically, a renal‑transplant patient on variable feeds could experience such swings, but the conflict lacks explicit context (e.g., insulin administration) to fully justify the drop, leaving a modest gap in realism. Overall, the conflict is acceptable and reasonably realistic, though it could be strengthened with more bridging information. \n\nScore: 4",
+ "conflict_type": "value",
+ "value": {
+ "start": 1567,
+ "end": 1638,
+ "text": "Current diet order / nutrition support: Boost glucose control @ 65ml/hr",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present contradictory glucose values: the first shows severe hyperglycemia (334 mg/dL, 312 mg/dL) on 5/7, while the second inserts a point‑of‑care reading of 80 mg/dL during discharge planning. The units are consistent, and the dates suggest the discharge reading could be later, making temporal compatibility plausible. Physiologically, glucose can fall from >300 to ~80 mg/dL with aggressive insulin or changes in nutrition, especially after tube‑feed adjustments, so the discrepancy is not impossible. Clinically, a renal‑transplant patient on variable feeds could experience such swings, but the conflict lacks explicit context (e.g., insulin administration) to fully justify the drop, leaving a modest gap in realism. Overall, the conflict is acceptable and reasonably realistic, though it could be strengthened with more bridging information. \n\nScore: 4",
+ "conflict_type": "value",
+ "value": {
+ "start": 12,
+ "end": 154,
+ "text": " Case reviewed w/ team, pt will need rehab. Cm left vm for ptPoint‑of‑care glucose measured at 80 mg/dL during the discharge planning visit.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hrAllergy: documented severe reaction to insulin (rash and anaphylaxis).\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.The care team plans to initiate basal‑bolus insulin therapy during the upcoming rehabilitation stay.\n",
+ "orig_doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "orig_doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "timestamp_1": "2182-05-07 15:01:00",
+ "timestamp_2": "2182-05-07 12:24:00",
+ "created_at": "2025-09-18T10:37:13.651874"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents describe the same patient at the same care transition, yet they present mutually exclusive statements: Document 1 records a documented severe insulin allergy (rash + anaphylaxis), while Document 2 plans to start basal‑bolus insulin therapy during rehabilitation. \n\n**Temporal compatibility:** Both notes refer to the current admission/re‑habitation period, so the conflict occurs contemporaneously. \n**Semantic normalization:** “Insulin” is the identical therapeutic agent in both statements, making the contradiction explicit. \n**Physiological plausibility:** Anaphylaxis to insulin, though rare, is a true contraindication; administering insulin would risk a life‑threatening reaction. \n**Clinical chain plausibility:** A care team would not schedule insulin without first addressing the allergy (e.g., using alternative agents, allergy testing, or desensitization). The plan is therefore clinically implausible. \n**Realistic reconciliation:** The conflict is realistic in that such documentation errors can occur, but a credible resolution would require either removing the insulin plan, documenting a confirmed false‑positive allergy, or specifying a non‑insulin glucose‑lowering regimen.\n\nThe conflict is well‑constructed, logically contradictory, and highlights a plausible documentation error that needs correction.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 1567,
+ "end": 1708,
+ "text": "Current diet order / nutrition support: Boost glucose control @ 65ml/hrAllergy: documented severe reaction to insulin (rash and anaphylaxis).",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents describe the same patient at the same care transition, yet they present mutually exclusive statements: Document 1 records a documented severe insulin allergy (rash + anaphylaxis), while Document 2 plans to start basal‑bolus insulin therapy during rehabilitation. \n\n**Temporal compatibility:** Both notes refer to the current admission/re‑habitation period, so the conflict occurs contemporaneously. \n**Semantic normalization:** “Insulin” is the identical therapeutic agent in both statements, making the contradiction explicit. \n**Physiological plausibility:** Anaphylaxis to insulin, though rare, is a true contraindication; administering insulin would risk a life‑threatening reaction. \n**Clinical chain plausibility:** A care team would not schedule insulin without first addressing the allergy (e.g., using alternative agents, allergy testing, or desensitization). The plan is therefore clinically implausible. \n**Realistic reconciliation:** The conflict is realistic in that such documentation errors can occur, but a credible resolution would require either removing the insulin plan, documenting a confirmed false‑positive allergy, or specifying a non‑insulin glucose‑lowering regimen.\n\nThe conflict is well‑constructed, logically contradictory, and highlights a plausible documentation error that needs correction.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 153,
+ "end": 268,
+ "text": "CM will follow.The care team plans to initiate basal‑bolus insulin therapy during the upcoming rehabilitation stay.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.Recent glucose checks have been stable, consistently ranging between 90‑110 mg/dL, indicating good control.\n",
+ "orig_doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "orig_doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "timestamp_1": "2182-05-07 15:01:00",
+ "timestamp_2": "2182-05-07 12:24:00",
+ "created_at": "2025-09-18T10:37:16.864764"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nDocument 1 records marked hyperglycemia (glucose 334 mg/dL, finger‑stick 312 mg/dL) on 2182‑05‑07, while Document 2 inserts a statement that “recent glucose checks have been stable, consistently ranging between 90‑110 mg/dL.” The two statements overlap temporally (both refer to the same recent period) and use the same semantic unit (“glucose”). Physiologically, such a rapid shift from >300 mg/dL to <110 mg/dL without intervention is implausible, especially in a 62‑year‑old renal‑transplant patient on tube feeds. Clinically, the conflict is realistic because glucose control can fluctuate, but the documents provide no reconciliation (e.g., treatment change), making the contradiction stark and acceptable for a conflict‑creation task. The conflict therefore satisfies temporal compatibility, semantic normalization, physiological plausibility (as a contradictory claim), clinical chain plausibility, and demonstrates a realistic need for reconciliation.\n\n**Score: 5**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 1703,
+ "end": 1735,
+ "text": "Assessment of Nutritional Status",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nDocument 1 records marked hyperglycemia (glucose 334 mg/dL, finger‑stick 312 mg/dL) on 2182‑05‑07, while Document 2 inserts a statement that “recent glucose checks have been stable, consistently ranging between 90‑110 mg/dL.” The two statements overlap temporally (both refer to the same recent period) and use the same semantic unit (“glucose”). Physiologically, such a rapid shift from >300 mg/dL to <110 mg/dL without intervention is implausible, especially in a 62‑year‑old renal‑transplant patient on tube feeds. Clinically, the conflict is realistic because glucose control can fluctuate, but the documents provide no reconciliation (e.g., treatment change), making the contradiction stark and acceptable for a conflict‑creation task. The conflict therefore satisfies temporal compatibility, semantic normalization, physiological plausibility (as a contradictory claim), clinical chain plausibility, and demonstrates a realistic need for reconciliation.\n\n**Score: 5**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 153,
+ "end": 275,
+ "text": "CM will follow.Recent glucose checks have been stable, consistently ranging between 90‑110 mg/dL, indicating good control.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for ptPhysical exam performed by the rehab team noted a firm, tender abdomen with guarding.\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "orig_doc_1": "Subjective\n Unable to speak with patient\n Objective\n Pertinent medications: Noted\n Labs:\n Value\n Date\n Glucose\n 334 mg/dL\n [**2182-5-7**] 02:46 AM\n Glucose Finger Stick\n 312\n [**2182-5-6**] 10:00 PM\n BUN\n 42 mg/dL\n [**2182-5-7**] 02:46 AM\n Creatinine\n 1.2 mg/dL\n [**2182-5-7**] 02:46 AM\n Sodium\n 142 mEq/L\n [**2182-5-7**] 02:46 AM\n Potassium\n 4.7 mEq/L\n [**2182-5-7**] 02:46 AM\n Chloride\n 108 mEq/L\n [**2182-5-7**] 02:46 AM\n TCO2\n 25 mEq/L\n [**2182-5-7**] 02:46 AM\n PO2 (arterial)\n 63 mm Hg\n [**2182-5-4**] 04:11 AM\n PO2 (venous)\n 187 mm Hg\n [**2182-5-5**] 03:16 PM\n PCO2 (arterial)\n 38 mm Hg\n [**2182-5-4**] 04:11 AM\n PCO2 (venous)\n 43 mm Hg\n [**2182-5-5**] 03:16 PM\n pH (arterial)\n 7.45 units\n [**2182-5-4**] 04:11 AM\n pH (venous)\n 7.38 units\n [**2182-5-5**] 03:16 PM\n pH (urine)\n 5.0 units\n [**2182-5-4**] 03:00 AM\n CO2 (Calc) arterial\n 27 mEq/L\n [**2182-5-4**] 04:11 AM\n CO2 (Calc) venous\n 26 mEq/L\n [**2182-5-5**] 03:16 PM\n Calcium non-ionized\n 8.5 mg/dL\n [**2182-5-7**] 02:46 AM\n Phosphorus\n 3.9 mg/dL\n [**2182-5-7**] 02:46 AM\n Magnesium\n 2.7 mg/dL\n [**2182-5-7**] 02:46 AM\n ALT\n 10 IU/L\n [**2182-5-4**] 05:39 AM\n Alkaline Phosphate\n 72 IU/L\n [**2182-5-4**] 05:39 AM\n AST\n 12 IU/L\n [**2182-5-4**] 05:39 AM\n Total Bilirubin\n 0.3 mg/dL\n [**2182-5-4**] 05:39 AM\n WBC\n 8.7 K/uL\n [**2182-5-7**] 02:46 AM\n Hgb\n 8.9 g/dL\n [**2182-5-7**] 02:46 AM\n Hematocrit\n 29.7 %\n [**2182-5-7**] 02:46 AM\n Current diet order / nutrition support: Boost glucose control @ 65ml/hr\n GI: Abdomen soft/ distended/ positive bowel sounds/flatus\n Assessment of Nutritional Status\n 62 yo male s/p renal transplant (\n03), with aspiration PNA, s/p trach\n yesterday, possible PEG placement.\n Tube feeds are currently at 35ml/hr (890kcals and 49g protein/day),\n continues to have labile blood glucose levels\n Medical Nutrition Therapy Plan - Recommend the Following\n 1. Continue to advance tube feeds to goal as tolerated to provide\n 1654kcals and 91g protein/day.\n 2. If PEG placed within the next 24 hours, start with 20ml/hr and\n advance to goal by increasing 10ml q 4hours.\n 3. Check residuals with PEG q 4hours, hold if >150ml\n 4. Monitor and replete electrolytes prn.\n 5. Continue with blood glucose management.\n Please page with questions #[**Numeric Identifier 5287**]\n 03:01 PM\n",
+ "orig_doc_2": "DC Planning\n Case reviewed w/ team, pt will need rehab. Cm left vm for pt\ns dtr,\n [**Name (NI) **], asking for call back to discuss rehab referrals. CM will follow.\n",
+ "timestamp_1": "2182-05-07 15:01:00",
+ "timestamp_2": "2182-05-07 12:24:00",
+ "created_at": "2025-09-18T10:37:20.752756"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two notes describe opposing abdominal findings: Document 1 records a “soft, distended, positive bowel sounds” exam, while Document 2 inserts a “firm, tender abdomen with guarding” exam. \n\n- **Temporal compatibility:** No timestamps are given; the exams could be from different shifts, making the conflict temporally plausible. \n- **Semantic normalization:** Both statements refer to the same physical exam domain, directly contradicting each other. \n- **Physiological plausibility:** Abdominal tone can change rapidly (e.g., evolving peritonitis), so the discrepancy is physiologically possible. \n- **Clinical chain plausibility:** A soft abdomen early after transplant could become tender if infection or ileus develops, fitting a realistic clinical trajectory. \n- **Realistic reconciliation:** The conflict can be resolved by attributing the findings to different time points or evolving pathology, which is a credible explanation.\n\n**Score: 5**",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 1642,
+ "end": 1699,
+ "text": "GI: Abdomen soft/ distended/ positive bowel sounds/flatus",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two notes describe opposing abdominal findings: Document 1 records a “soft, distended, positive bowel sounds” exam, while Document 2 inserts a “firm, tender abdomen with guarding” exam. \n\n- **Temporal compatibility:** No timestamps are given; the exams could be from different shifts, making the conflict temporally plausible. \n- **Semantic normalization:** Both statements refer to the same physical exam domain, directly contradicting each other. \n- **Physiological plausibility:** Abdominal tone can change rapidly (e.g., evolving peritonitis), so the discrepancy is physiologically possible. \n- **Clinical chain plausibility:** A soft abdomen early after transplant could become tender if infection or ileus develops, fitting a realistic clinical trajectory. \n- **Realistic reconciliation:** The conflict can be resolved by attributing the findings to different time points or evolving pathology, which is a credible explanation.\n\n**Score: 5**",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 15,
+ "end": 160,
+ "text": "Case reviewed w/ team, pt will need rehab. Cm left vm for ptPhysical exam performed by the rehab team noted a firm, tender abdomen with guarding.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\nThere is no evidence of a left middle cerebral artery (MCA) stroke on imaging or clinical examination.\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "orig_doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "orig_doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "timestamp_1": "2120-05-04 05:41:00",
+ "timestamp_2": "2120-05-04 04:32:00",
+ "created_at": "2025-09-18T10:37:43.620090"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "Both documents refer to the same 86‑year‑old patient but present opposite imaging conclusions: Document 1 states *“There is no evidence of a left MCA stroke on imaging or clinical examination,”* while Document 2 describes a hyperdense left MCA sign and early insular loss prompting IV tPA. \n\n- **Temporal compatibility:** The CT in Document 2 is performed early (tPA given at 18:21); Document 1’s report is timestamped 5:41 AM the same day, suggesting a later scan that could plausibly show no infarct after reperfusion, so the timing can reconcile the conflict. \n- **Semantic normalization:** Both refer to the same vascular territory (left MCA) and use consistent terminology, making the contradiction clear. \n- **Physiological plausibility:** Recanalization after tPA can eliminate the hyperdense clot and reduce visible ischemia, so a later negative study is plausible. \n- **Clinical chain plausibility:** The sequence (initial positive CT → tPA → possible resolution) follows a realistic stroke care pathway. \n- **Realistic reconciliation:** A reasonable explanation would note that the early CT showed a clot, while a subsequent non‑contrast scan showed no residual stroke evidence, reflecting successful treatment. \n\nOverall, the conflict is well‑crafted, medically plausible, and allows a credible reconciliation, demonstrating strong use of the evaluation dimensions.\n\n**Score: 4**",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 446,
+ "end": 548,
+ "text": "There is no evidence of a left middle cerebral artery (MCA) stroke on imaging or clinical examination.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense right MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "orig_doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "orig_doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "timestamp_1": "2120-05-04 05:41:00",
+ "timestamp_2": "2120-05-04 04:32:00",
+ "created_at": "2025-09-18T10:37:47.424960"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents describe the same 86‑year‑old stroke patient, but they disagree on the affected hemisphere. Document 1 identifies a “left MCA stroke,” while Document 2’s CT finding was altered from “hyperdense left MCA” to “hyperdense right MCA,” creating a laterality conflict. Temporal compatibility is intact (both refer to the same admission date). Semantic normalization shows a clear opposite laterality. Physiologically both left‑ and right‑MCA infarcts are plausible, yet the clinical picture (aphasia + right‑side weakness) aligns with a left‑hemisphere lesion, making the right‑MCA claim less coherent. The clinical chain therefore breaks, but the conflict is realistic (laterality errors are common) and can be reconciled by assuming a documentation error in one source. \n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 448,
+ "end": 505,
+ "text": "86 year old woman with likely left MCA stroke, s/p IV tPA",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents describe the same 86‑year‑old stroke patient, but they disagree on the affected hemisphere. Document 1 identifies a “left MCA stroke,” while Document 2’s CT finding was altered from “hyperdense left MCA” to “hyperdense right MCA,” creating a laterality conflict. Temporal compatibility is intact (both refer to the same admission date). Semantic normalization shows a clear opposite laterality. Physiologically both left‑ and right‑MCA infarcts are plausible, yet the clinical picture (aphasia + right‑side weakness) aligns with a left‑hemisphere lesion, making the right‑MCA claim less coherent. The clinical chain therefore breaks, but the conflict is realistic (laterality errors are common) and can be reconciled by assuming a documentation error in one source. \n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 409,
+ "end": 446,
+ "text": "Head CT showed a hyperdense right MCA",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B Blood pressure measured at the time of the scan was 110/70 mmHg.\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "orig_doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "orig_doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "timestamp_1": "2120-05-04 05:41:00",
+ "timestamp_2": "2120-05-04 04:32:00",
+ "created_at": "2025-09-18T10:38:08.933022"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two edits affect vital‑sign data at different moments: Document 1 inserts a scan‑time BP of 110/70 mmHg (date 2120‑05‑04, 5:41 AM), while Document 2 adds a bedside VS line showing BP 143/99 mmHg (temp 97.5 °F, HR 106). Temporal compatibility is maintained because the timestamps differ, so the values could coexist. Semantic normalization shows both entries use standard BP notation. Physiologically, both readings are plausible for an 86‑year‑old with acute MCA stroke and atrial fibrillation. Clinically, a lower BP at imaging (to reduce hemorrhagic risk) and a higher admission BP are realistic. Reconciliation is straightforward: the conflict is acceptable and reflects realistic clinical variability rather than an impossible contradiction. \n\n**Score: 5**",
+ "conflict_type": "value",
+ "value": {
+ "start": 94,
+ "end": 158,
+ "text": "Blood pressure measured at the time of the scan was 110/70 mmHg.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two edits affect vital‑sign data at different moments: Document 1 inserts a scan‑time BP of 110/70 mmHg (date 2120‑05‑04, 5:41 AM), while Document 2 adds a bedside VS line showing BP 143/99 mmHg (temp 97.5 °F, HR 106). Temporal compatibility is maintained because the timestamps differ, so the values could coexist. Semantic normalization shows both entries use standard BP notation. Physiologically, both readings are plausible for an 86‑year‑old with acute MCA stroke and atrial fibrillation. Clinically, a lower BP at imaging (to reduce hemorrhagic risk) and a higher admission BP are realistic. Reconciliation is straightforward: the conflict is acceptable and reflects realistic clinical variability rather than an impossible contradiction. \n\n**Score: 5**",
+ "conflict_type": "value",
+ "value": {
+ "start": 1149,
+ "end": 1206,
+ "text": "VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n The patient has a documented severe iodine allergy, which is a contraindication to IV contrast administration.\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCAThe study was performed with intravenous iodinated contrast. and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "orig_doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "orig_doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "timestamp_1": "2120-05-04 05:41:00",
+ "timestamp_2": "2120-05-04 04:32:00",
+ "created_at": "2025-09-18T10:38:11.413508"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same 86‑year‑old stroke patient, but Document 1 explicitly records a severe iodine allergy that makes IV contrast contraindicated, while Document 2 states that the head CT was performed **with** intravenous iodinated contrast. The temporal overlap (same admission date) and identical clinical details make the conflict direct. Semantic normalization shows the allergy clause and contrast‑use clause refer to the same imaging event. Physiologically, administering iodinated contrast to a severely iodine‑allergic patient would risk anaphylaxis, rendering the scenario implausible without pre‑medication. Clinically, a radiology team would normally avoid contrast in such a case, so the chain of events in Document 2 is unlikely. A realistic reconciliation would note a documentation error or that the contrast‑free CT was intended but mistakenly described as contrast‑enhanced. The conflict is clear, medically coherent, and plausible as an intentional factual clash for testing purposes.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 605,
+ "end": 715,
+ "text": "The patient has a documented severe iodine allergy, which is a contraindication to IV contrast administration.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same 86‑year‑old stroke patient, but Document 1 explicitly records a severe iodine allergy that makes IV contrast contraindicated, while Document 2 states that the head CT was performed **with** intravenous iodinated contrast. The temporal overlap (same admission date) and identical clinical details make the conflict direct. Semantic normalization shows the allergy clause and contrast‑use clause refer to the same imaging event. Physiologically, administering iodinated contrast to a severely iodine‑allergic patient would risk anaphylaxis, rendering the scenario implausible without pre‑medication. Clinically, a radiology team would normally avoid contrast in such a case, so the chain of events in Document 2 is unlikely. A realistic reconciliation would note a documentation error or that the contrast‑free CT was intended but mistakenly described as contrast‑enhanced. The conflict is clear, medically coherent, and plausible as an intentional factual clash for testing purposes.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 409,
+ "end": 505,
+ "text": "Head CT showed a hyperdense left MCAThe study was performed with intravenous iodinated contrast.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed no evidence of left middle cerebral artery (MCA) ischemia or hyperdensity. The scan is unremarkable for acute stroke changes. and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "orig_doc_1": "[**Last Name (LF) **],[**First Name3 (LF) **] NMED SICU-B [**2120-5-4**] 5:41 AM\n CT HEAD W/O CONTRAST Clip # [**Clip Number (Radiology) 87385**]\n Reason: evaluate for interval change\n Admitting Diagnosis: STROKE;TELEMETRY;TRANSIENT ISCHEMIC ATTACK\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 86 year old woman with likely left MCA stroke, s/p IV tPA\n REASON FOR THIS EXAMINATION:\n evaluate for interval change\n CONTRAINDICATIONS for IV CONTRAST:\n cr\n ______________________________________________________________________________\n PFI REPORT\n Worsening of left MCA territory ischemia. D/W Dr. [**Last Name (STitle) 79596**] 6:30a [**2120-5-4**]\n\n",
+ "orig_doc_2": "SICU\n HPI:\n The patient is an 86 year old right handed Albanian speaking woman with\n a history of CHF, paroxysmal atrial fibrillation not on Coumadin, and\n kidney cyst s/p removal who presents with acute onset aphasia and right\n sided weakness for whom neurology was called for a CODE STROKE. NIHSS\n score was 14 for aphasia, intermittently following commands, and right\n face/arm/leg weakness. Head CT showed a hyperdense left MCA and early\n loss of the left insular ribbon, so she was given IV tPA. IV tPA was\n given at 18:21. Initially, the patient's daughter-in-law reported the\n patient had never had symptoms like this before, but upon arrival of\n other family members the patient had similar but less intense symptoms\n 5 years ago. Her daughter-in-law also initially said that she did not\n have an arrythmia, but later other family members said she has a\n history of paroxysmal atrial fibrillation. She was started on Coumadin\n 5 years ago, but refused to take it after 2 months. She has most likely\n had a cardioembolic stroke in the setting of atrial fibrillation for\n which she is not anti-coagulated.\n VS: temp 97.5, HR 106, bp 143/99, RR 22, SaO2 100% on NRB\n PE: appears alert. aphasic. trying to communicate. low 90s% on 3L\n NC. HR 130s A-fib RVR, BP 130s/90s\n Chief complaint:\n acute onset aphasia and right sided weakness\n PMHx:\n CHF, paroxysmal atrial fibrillation not on Coumadin, ? HTN, CRI,\n Diverticulitis\n Current medications:\n Active Medications [**Known lastname 14388**],[**Known firstname 14389**]\n 1. 2. Acetaminophen 3. Bumetanide 4. Dextrose 50% 5. Diltiazem 6.\n Diltiazem 7. Ethacrynic Acid\n 8. Glucagon 9. HydrALAzine 10. Insulin 11. Metoprolol Tartrate 12.\n Metoprolol Tartrate 13. Pantoprazole\n 14. Phenylephrine 15. Sodium Chloride 0.9% Flush\n 24 Hour Events:\n Admitted. Bumex. Dilt gtt (5), metoprolol PRN, Neo PRN (0.9).\n Allergies:\n Lasix (Oral) (Furosemide)\n Unknown;\n Motrin (Oral) (Ibuprofen)\n Abdominal pain;\n Last dose of Antibiotics:\n Infusions:\n Diltiazem - 5 mg/hour\n Phenylephrine - 0.9 mcg/Kg/min\n Other ICU medications:\n Metoprolol - [**2120-5-3**] 10:55 PM\n Diltiazem - [**2120-5-4**] 12:20 AM\n Pantoprazole (Protonix) - [**2120-5-4**] 12:30 AM\n Other medications:\n Flowsheet Data as of [**2120-5-4**] 04:32 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**22**] a.m.\n Tmax: 36\nC (96.8\n T current: 36\nC (96.8\n HR: 114 (103 - 131) bpm\n BP: 113/86(90) {113/72(63) - 143/151(121)} mmHg\n RR: 23 (17 - 29) insp/min\n SPO2: 99%\n Heart rhythm: AF (Atrial Fibrillation)\n Total In:\n 250 mL\n 78 mL\n PO:\n Tube feeding:\n IV Fluid:\n 50 mL\n 78 mL\n Blood products:\n Total out:\n 1,420 mL\n 930 mL\n Urine:\n 220 mL\n 930 mL\n NG:\n Stool:\n Drains:\n Balance:\n -1,170 mL\n -852 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 99%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress, Well nourished\n HEENT: PERRL\n Cardiovascular: (Rhythm: Irregular), IR IR\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :\n bilateral), (Sternum: Stable )\n Abdominal: Soft\n Left Extremities: (Edema: 2+), (Temperature: Warm), (Pulse - Dorsalis\n pedis: Diminished)\n Right Extremities: (Edema: 2+), (Pulse - Dorsalis pedis: Diminished)\n Neurologic: Follows simple commands, (Responds to: Verbal stimuli,\n Tactile stimuli), Moves all extremities\n Labs / Radiology\n 390 K/uL\n 15.2 g/dL\n 45.9 %\n 13.3 K/uL\n [image002.jpg]\n [**2120-5-4**] 03:23 AM\n WBC\n 13.3\n Hct\n 45.9\n Plt\n 390\n Assessment and Plan\n CVA (STROKE, CEREBRAL INFARCTION), ISCHEMIC , PULMONARY EDEMA\n Assessment and Plan: 86 yo F with h/o CHF, paroxysmal atrial\n fibrillation not on Coumadin now with had a cardioembolic stroke s/p\n tPA\n Neurologic: - Neuro checks: q1h check\n --f/u on repeated head CT in AM, STAT if any acute neurological changes\n - MRI/MRA head/neck when stable\n - Avoid arterial puncture, avoid antiplatelets/anticoag for 24hrs\n - Avoid instrumentation x 24hrs\n --Tylenol prn euthermia and pain\n Cardiovascular: - dilt gtt for a-fib. Please increase to better control\n rate to keep around 80s\n - bumex for ? CHF exerbations\n - Allow blood pressure to autoregulate (SBP 140-160 is ideal), but keep\n SBP<185 and DBP<105, continue on neo to maintain goal BPs\n - Will hold home Verapamil, Gabapentin, and ASA for now, will try to\n give Edecrin via NG tube when placed\n Pulmonary: - diurese with bumex\n - repeat CXR\n - consider Chest CT\n Gastrointestinal / Abdomen: - NPO\n - Prophylaxis with PPI. Please change to H2 blocker.\n Nutrition: --NPO.\n Renal: --Baseline creatinine of 1.9 [**3-5**] CRI. Hold off on diuresis\n unless symptomatic\n Hematology: -- Hct 42.\n Endocrine: --RISS but hyperglycemic. Please aggressively manage\n hyperglycemia with RISS with a goal BG<150\n Infectious Disease: -- consider Abx in setting of? CHF excerbation.\n Lines / Tubes / Drains: PIVx2, Foley\n Wounds:\n Imaging:\n Fluids: KVO\n Consults: Neurology\n Billing Diagnosis:\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2120-5-3**] 10:00 PM\n 20 Gauge - [**2120-5-3**] 10:00 PM\n Prophylaxis:\n DVT: Boots (tPA)\n Stress ulcer: PPI. Please change to H2 blocker\n VAP bundle: HOB elevation\n Comments:\n Communication: Patient discussed on interdisciplinary rounds , Family\n meeting held , ICU consent signed Comments:\n Code status: Full code\n Disposition: ICU\n Total time spent: 20 minutes\n",
+ "timestamp_1": "2120-05-04 05:41:00",
+ "timestamp_2": "2120-05-04 04:32:00",
+ "created_at": "2025-09-18T10:38:25.639515"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two reports create a clear clinical contradiction: Document 1 asserts “Worsening of left MCA territory ischemia,” implying new or progressive infarction, while Document 2 states the head CT “showed no evidence of left MCA ischemia or hyperdensity” and was “unremarkable for acute stroke changes.” This conflict is temporally plausible (early CT can be negative, later imaging may reveal worsening), semantically coherent, physiologically possible, and reflects a realistic diagnostic dilemma, though the documents do not explicitly align timestamps to resolve the discrepancy. Overall, the conflict is well‑crafted and clinically credible.\n\nScore: 4",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 734,
+ "end": 775,
+ "text": "Worsening of left MCA territory ischemia.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two reports create a clear clinical contradiction: Document 1 asserts “Worsening of left MCA territory ischemia,” implying new or progressive infarction, while Document 2 states the head CT “showed no evidence of left MCA ischemia or hyperdensity” and was “unremarkable for acute stroke changes.” This conflict is temporally plausible (early CT can be negative, later imaging may reveal worsening), semantically coherent, physiologically possible, and reflects a realistic diagnostic dilemma, though the documents do not explicitly align timestamps to resolve the discrepancy. Overall, the conflict is well‑crafted and clinically credible.\n\nScore: 4",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 409,
+ "end": 549,
+ "text": "Head CT showed no evidence of left middle cerebral artery (MCA) ischemia or hyperdensity. The scan is unremarkable for acute stroke changes.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 5\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, uncuffed\n Manufacturer: Portex\n Size: 7.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 37 cmH2O\n Cuff volume: mL /\n Airway problems: P > 30cm/H2O\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Rhonchi\n LUL Lung Sounds: Rhonchi\n LLL Lung Sounds: Diminished\n Secretions\n Sputum color / consistency: White / Thick\n Sputum source/amount: Suctioned / Small\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Underlying illness\n not resolved\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 7\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, Cuffed, Inner Cannula\n Manufacturer: Portex\n Size: 7.0mm\n Cuff Management:\n Vol/Press:\n Cuff pressure: 38 cmH2O\n Cuff volume: 10 mL /\n Airway problems: P > 30cm/H2O, Positional leak around\n cuff\n Lung sounds\n RLL Lung Sounds: Insp Wheeze\n RUL Lung Sounds: Insp Wheeze\n LUL Lung Sounds: Insp Wheeze\n LLL Lung Sounds: Insp Wheeze\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Moderate\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Assessment of breathing comfort: No claim of dyspnea)\n Invasive ventilation assessment:\n Trigger work assessment: Triggering synchronously\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Cannot protect\n airway, Underlying illness not resolved\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 5\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 7.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 37 cmH2O\n Cuff volume: mL /\n Airway problems: P > 30cm/H2O\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Rhonchi\n LUL Lung Sounds: Rhonchi\n LLL Lung Sounds: Diminished\n Secretions\n Sputum color / consistency: White / Thick\n Sputum source/amount: Suctioned / Small\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Underlying illness\n not resolved\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 7\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, Cuffed, Inner Cannula\n Manufacturer: Portex\n Size: 7.0mm\n Cuff Management:\n Vol/Press:\n Cuff pressure: 38 cmH2O\n Cuff volume: 10 mL /\n Airway problems: P > 30cm/H2O, Positional leak around\n cuff\n Lung sounds\n RLL Lung Sounds: Insp Wheeze\n RUL Lung Sounds: Insp Wheeze\n LUL Lung Sounds: Insp Wheeze\n LLL Lung Sounds: Insp Wheeze\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Moderate\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Assessment of breathing comfort: No claim of dyspnea)\n Invasive ventilation assessment:\n Trigger work assessment: Triggering synchronously\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Cannot protect\n airway, Underlying illness not resolved\n",
+ "timestamp_1": "2122-09-06 04:53:00",
+ "timestamp_2": "2122-09-08 05:07:00",
+ "created_at": "2025-09-18T10:38:46.232804"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present a coherent, clinically plausible conflict: Document 1 describes a standard uncuffed tracheostomy tube (cuff pressure 37 cmH₂O, no inner cannula) on ventilation day 5, while Document 2 records a standard cuffed tube with an inner cannula (cuff pressure 38 cmH₂O) on day 7, together with expected changes in lung sounds, sputum characteristics, and ventilation needs. Temporal compatibility is maintained (the later assessment naturally shows progression), semantic normalization highlights the differing tube specifications, physiological plausibility is sound (cuffed tubes are often added when airway protection is required), and the clinical chain (increased cuff pressure, leak, worsening secretions) logically supports the shift. The only shortcoming is that the listed “conflict” annotations redundantly state the same replacement text, which detracts slightly from clarity. Overall, the conflict is realistic, multidimensional, and well‑reconciled. \n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 265,
+ "end": 289,
+ "text": "Type: Standard, uncuffed",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present a coherent, clinically plausible conflict: Document 1 describes a standard uncuffed tracheostomy tube (cuff pressure 37 cmH₂O, no inner cannula) on ventilation day 5, while Document 2 records a standard cuffed tube with an inner cannula (cuff pressure 38 cmH₂O) on day 7, together with expected changes in lung sounds, sputum characteristics, and ventilation needs. Temporal compatibility is maintained (the later assessment naturally shows progression), semantic normalization highlights the differing tube specifications, physiological plausibility is sound (cuffed tubes are often added when airway protection is required), and the clinical chain (increased cuff pressure, leak, worsening secretions) logically supports the shift. The only shortcoming is that the listed “conflict” annotations redundantly state the same replacement text, which detracts slightly from clarity. Overall, the conflict is realistic, multidimensional, and well‑reconciled. \n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 265,
+ "end": 302,
+ "text": "Type: Standard, Cuffed, Inner Cannula",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 5\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n The patient has a documented allergy to Portex material.\n Size: 7.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 37 cmH2O\n Cuff volume: mL /\n Airway problems: P > 30cm/H2O\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Rhonchi\n LUL Lung Sounds: Rhonchi\n LLL Lung Sounds: Diminished\n Secretions\n Sputum color / consistency: White / Thick\n Sputum source/amount: Suctioned / Small\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Underlying illness\n not resolved\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 7\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, Cuffed, Inner Cannula\n Manufacturer: Portex\n Size: 7.0mm\n Cuff Management:\n Vol/Press:\n Cuff pressure: 38 cmH2O\n Cuff volume: 10 mL /\n Airway problems: P > 30cm/H2O, Positional leak around\n cuff\n Lung sounds\n RLL Lung Sounds: Insp Wheeze\n RUL Lung Sounds: Insp Wheeze\n LUL Lung Sounds: Insp Wheeze\n LLL Lung Sounds: Insp Wheeze\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Moderate\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Assessment of breathing comfort: No claim of dyspnea)\n Invasive ventilation assessment:\n Trigger work assessment: Triggering synchronously\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Cannot protect\n airway, Underlying illness not resolved\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 5\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 7.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 37 cmH2O\n Cuff volume: mL /\n Airway problems: P > 30cm/H2O\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Rhonchi\n LUL Lung Sounds: Rhonchi\n LLL Lung Sounds: Diminished\n Secretions\n Sputum color / consistency: White / Thick\n Sputum source/amount: Suctioned / Small\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Underlying illness\n not resolved\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 7\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, Cuffed, Inner Cannula\n Manufacturer: Portex\n Size: 7.0mm\n Cuff Management:\n Vol/Press:\n Cuff pressure: 38 cmH2O\n Cuff volume: 10 mL /\n Airway problems: P > 30cm/H2O, Positional leak around\n cuff\n Lung sounds\n RLL Lung Sounds: Insp Wheeze\n RUL Lung Sounds: Insp Wheeze\n LUL Lung Sounds: Insp Wheeze\n LLL Lung Sounds: Insp Wheeze\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Moderate\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Assessment of breathing comfort: No claim of dyspnea)\n Invasive ventilation assessment:\n Trigger work assessment: Triggering synchronously\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Cannot protect\n airway, Underlying illness not resolved\n",
+ "timestamp_1": "2122-09-06 04:53:00",
+ "timestamp_2": "2122-09-08 05:07:00",
+ "created_at": "2025-09-18T10:38:58.029211"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe a Portex tracheostomy tube of identical size, but Document 1 adds a documented allergy to Portex material, while Document 2 retains the same tube without any allergy note. The temporal data (ventilation day 5 vs 7) are compatible, and terminology is consistent, so the conflict is semantically clear. Physiologically, using a tube to which the patient is allergic is implausible and would normally trigger a change in equipment, making the conflict clinically realistic. The inconsistency creates a believable clinical dilemma that can be reconciled by substituting a non‑Portex tube, satisfying all evaluation dimensions.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 280,
+ "end": 395,
+ "text": " Manufacturer: Portex\n The patient has a documented allergy to Portex material.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe a Portex tracheostomy tube of identical size, but Document 1 adds a documented allergy to Portex material, while Document 2 retains the same tube without any allergy note. The temporal data (ventilation day 5 vs 7) are compatible, and terminology is consistent, so the conflict is semantically clear. Physiologically, using a tube to which the patient is allergic is implausible and would normally trigger a change in equipment, making the conflict clinically realistic. The inconsistency creates a believable clinical dilemma that can be reconciled by substituting a non‑Portex tube, satisfying all evaluation dimensions.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 303,
+ "end": 342,
+ "text": " Manufacturer: Portex",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 5\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 7.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 37 cmH2O\n Cuff volume: mL /\n Airway problems: P > 30cm/H2O\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Rhonchi\n LUL Lung Sounds: Rhonchi\n LLL Lung Sounds: Diminished\n Secretions\n Sputum color / consistency: White / Thick\n Sputum source/amount: Suctioned / Small\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Underlying illness\n not resolved\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 7\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, Cuffed, Inner Cannula\n Manufacturer: Portex\n Size: 7.0mm\n Cuff Management:\n Vol/Press:\n Cuff pressure: 38 cmH2O\n Cuff volume: 10 mL /\n Airway problems: P > 30cm/H2O, Positional leak around\n cuff\n Lung sounds\n RLL Lung Sounds: Insp Wheeze\n RUL Lung Sounds: Insp Wheeze\n LUL Lung Sounds: Insp Wheeze\n LLL Lung Sounds: Insp Wheeze\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum amount is moderate, up from a small amount noted 48 hours earlier\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Assessment of breathing comfort: No claim of dyspnea)\n Invasive ventilation assessment:\n Trigger work assessment: Triggering synchronously\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Cannot protect\n airway, Underlying illness not resolved\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 5\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 7.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 37 cmH2O\n Cuff volume: mL /\n Airway problems: P > 30cm/H2O\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Rhonchi\n LUL Lung Sounds: Rhonchi\n LLL Lung Sounds: Diminished\n Secretions\n Sputum color / consistency: White / Thick\n Sputum source/amount: Suctioned / Small\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Underlying illness\n not resolved\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 7\n Ideal body weight: 49.9 None\n Ideal tidal volume: 199.6 / 299.4 / 399.2 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: Yes\n Tracheostomy tube:\n Type: Standard, Cuffed, Inner Cannula\n Manufacturer: Portex\n Size: 7.0mm\n Cuff Management:\n Vol/Press:\n Cuff pressure: 38 cmH2O\n Cuff volume: 10 mL /\n Airway problems: P > 30cm/H2O, Positional leak around\n cuff\n Lung sounds\n RLL Lung Sounds: Insp Wheeze\n RUL Lung Sounds: Insp Wheeze\n LUL Lung Sounds: Insp Wheeze\n LLL Lung Sounds: Insp Wheeze\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Moderate\n Ventilation Assessment\n Level of breathing assistance: Continuous invasive ventilation\n Visual assessment of breathing pattern: Normal quiet breathing\n Assessment of breathing comfort: No claim of dyspnea)\n Invasive ventilation assessment:\n Trigger work assessment: Triggering synchronously\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support: Cannot protect\n airway, Underlying illness not resolved\n",
+ "timestamp_1": "2122-09-06 04:53:00",
+ "timestamp_2": "2122-09-08 05:07:00",
+ "created_at": "2025-09-18T10:39:00.916930"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same patient at different time points (ventilation day 5 vs 7). The sputum change from “small, suctioned” to “moderate, up from a small amount 48 h earlier” is temporally compatible and physiologically plausible for a worsening airway secretion load. Other parameters (cuff pressure, lung sounds) also shift realistically over two days. Conflict 1, however, merely repeats the original wording, offering no substantive alteration, which weakens the overall conflict design. Overall, the core conflict is coherent and clinically credible, though the first conflict statement is trivial.\n\n**Score: 4**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 786,
+ "end": 825,
+ "text": "Sputum source/amount: Suctioned / Small",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same patient at different time points (ventilation day 5 vs 7). The sputum change from “small, suctioned” to “moderate, up from a small amount 48 h earlier” is temporally compatible and physiologically plausible for a worsening airway secretion load. Other parameters (cuff pressure, lung sounds) also shift realistically over two days. Conflict 1, however, merely repeats the original wording, offering no substantive alteration, which weakens the overall conflict design. Overall, the core conflict is coherent and clinically credible, though the first conflict statement is trivial.\n\n**Score: 4**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 826,
+ "end": 898,
+ "text": "Sputum amount is moderate, up from a small amount noted 48 hours earlier",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness and headache\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "orig_doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "orig_doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "timestamp_1": "2129-03-20 14:45:00",
+ "timestamp_2": "2129-03-20 04:05:00",
+ "created_at": "2025-09-18T10:39:29.223479"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same patient with an external ventricular drain. Document 1 explicitly states the patient *denies headache*, while Document 2 lists *headache* as a chief complaint. This creates a direct semantic conflict (headache present vs absent) that is temporally compatible (same admission), physiologically plausible (headache is common in hydrocephalus), and clinically realistic (discrepancies between nursing notes and physician assessment occur). The modifications themselves are minor wording changes, but they generate a clear, believable inconsistency that would require reconciliation in real practice.\n\n**Score: 5**",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 305,
+ "end": 335,
+ "text": "denies head ache or other pain",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same patient with an external ventricular drain. Document 1 explicitly states the patient *denies headache*, while Document 2 lists *headache* as a chief complaint. This creates a direct semantic conflict (headache present vs absent) that is temporally compatible (same admission), physiologically plausible (headache is common in hydrocephalus), and clinically realistic (discrepancies between nursing notes and physician assessment occur). The modifications themselves are minor wording changes, but they generate a clear, believable inconsistency that would require reconciliation in real practice.\n\n**Score: 5**",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 171,
+ "end": 193,
+ "text": "Dizziness and headache",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:The patient does not have a urinary catheter in place.\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "orig_doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "orig_doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "timestamp_1": "2129-03-20 14:45:00",
+ "timestamp_2": "2129-03-20 04:05:00",
+ "created_at": "2025-09-18T10:39:33.422833"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two modifications generate a clear clinical inconsistency: Document 1 records a functioning Foley catheter with urine output, while Document 2 inserts the statement “The patient does not have a urinary catheter in place,” directly contradicting catheter status. This conflict is temporally compatible (both notes refer to the same admission period), semantically normalized (both describe urinary drainage), physiologically plausible (a patient could be catheterized or not), and fits a realistic clinical chain (catheter presence affects fluid balance and infection risk). The added “...” after the transfer plan in Document 1, however, does not create a substantive conflict and appears filler, reducing overall conflict richness. Considering the strong, realistic contradiction about the catheter but the weak filler edit, the conflict quality is solid but not flawless.\n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 695,
+ "end": 759,
+ "text": "Allergies:The patient does not have a urinary catheter in place.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 110/70 (MAP 83 mmHg)\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "orig_doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "orig_doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "timestamp_1": "2129-03-20 14:45:00",
+ "timestamp_2": "2129-03-20 04:05:00",
+ "created_at": "2025-09-18T10:39:36.688035"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two notes describe the same patient with an external ventricular drain, but they report markedly different systolic blood pressures (140‑160 mmHg vs 110 mmHg). Both values are physiologically plausible, yet without a clear temporal cue or therapeutic context the discrepancy feels abrupt. Semantic normalization shows a consistent BP concept, but the conflict lacks explicit timing (e.g., “earlier” vs “now”) to justify the change, reducing temporal compatibility. Clinically, a drop from hypertensive to normotensive values could occur after antihypertensive treatment, but the documents do not mention such an intervention, limiting realistic reconciliation. Overall the conflict is plausible but only partially justified.\n\nScore: 4",
+ "conflict_type": "value",
+ "value": {
+ "start": 1408,
+ "end": 1432,
+ "text": "BP: 110/70 (MAP 83 mmHg)",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin 5. Lisinopril 10 mg PO daily\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "orig_doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "orig_doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "timestamp_1": "2129-03-20 14:45:00",
+ "timestamp_2": "2129-03-20 04:05:00",
+ "created_at": "2025-09-18T10:39:40.151219"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe first “conflict” merely repeats the same allergy entry, offering no substantive discrepancy, so it fails to create a meaningful factual clash. The second conflict introduces Lisinopril into the medication list while the allergy section still lists Lisinopril as an allergen, producing a clear, clinically plausible contradiction (a patient cannot safely receive a drug they are allergic to). This clash respects temporal compatibility (both entries refer to the same admission), semantic normalization (same drug name and dosage), physiological plausibility (allergy‑induced adverse reaction), and clinical chain plausibility (prescribing error). The conflict is realistic, but the overall pair is weakened by the trivial first alteration, yielding a solid but not perfect evaluation.\n\n**Score: 4**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 1862,
+ "end": 1920,
+ "text": "Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe first “conflict” merely repeats the same allergy entry, offering no substantive discrepancy, so it fails to create a meaningful factual clash. The second conflict introduces Lisinopril into the medication list while the allergy section still lists Lisinopril as an allergen, producing a clear, clinically plausible contradiction (a patient cannot safely receive a drug they are allergic to). This clash respects temporal compatibility (both entries refer to the same admission), semantic normalization (same drug name and dosage), physiological plausibility (allergy‑induced adverse reaction), and clinical chain plausibility (prescribing error). The conflict is realistic, but the overall pair is weakened by the trivial first alteration, yielding a solid but not perfect evaluation.\n\n**Score: 4**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 429,
+ "end": 473,
+ "text": "4. Atorvastatin 5. Lisinopril 10 mg PO daily",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation, Current temperature: 36.5 °C (97.7 °F).\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "orig_doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "orig_doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "timestamp_1": "2129-03-20 14:45:00",
+ "timestamp_2": "2129-03-20 04:05:00",
+ "created_at": "2025-09-18T10:40:03.937678"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents now present conflicting temperature data for the same patient: Document 1 reports a current temperature of 36.5 °C, while Document 2 shows a recent Tmax of 38.3 °C and a current temperature of 37.6 °C. Temporally, the measurements could be from different shifts, but the conflict is not explicitly time‑stamped, reducing temporal compatibility. Semantically both refer to core body temperature, so normalization is straightforward. Physiologically, a range from 36.5 °C to 38.3 °C is plausible in a neuro‑ICU patient with infection or inflammation. Clinically, the higher temperature aligns with the documented antibiotics and possible infection, making the lower value less plausible without an intervening antipyretic. A realistic reconciliation would note a trend (e.g., “temperature decreased from 38.3 °C earlier to 36.5 °C now”) or specify measurement times. The conflict is therefore realistic but could be improved by adding timestamps.\n\n**Score: 5**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 697,
+ "end": 811,
+ "text": " Resp: Clear upper lobes and diminished lower lobes upon auscultation, Current temperature: 36.5 °C (97.7 °F).",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents now present conflicting temperature data for the same patient: Document 1 reports a current temperature of 36.5 °C, while Document 2 shows a recent Tmax of 38.3 °C and a current temperature of 37.6 °C. Temporally, the measurements could be from different shifts, but the conflict is not explicitly time‑stamped, reducing temporal compatibility. Semantically both refer to core body temperature, so normalization is straightforward. Physiologically, a range from 36.5 °C to 38.3 °C is plausible in a neuro‑ICU patient with infection or inflammation. Clinically, the higher temperature aligns with the documented antibiotics and possible infection, making the lower value less plausible without an intervening antipyretic. A realistic reconciliation would note a trend (e.g., “temperature decreased from 38.3 °C earlier to 36.5 °C now”) or specify measurement times. The conflict is therefore realistic but could be improved by adding timestamps.\n\n**Score: 5**",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 1331,
+ "end": 1344,
+ "text": " Tmax: 38.3",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:The patient exhibits a productive cough with yellow sputum.\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "orig_doc_1": "N: Pt remains alert and oriented to person and place but difficult to\n assess orientation to situation and time. PERRLA R 3-4 mm and brisk, L\n 2-3 mm and brisk, follows all simple commands, symmetrical muscle tone\n in face, equal strength bilaterally, intact sensation all extremities\n and torso, denies head ache or other pain, EVD 10 cm above the tragus\n and open to transducer and drain, pink CSF at approximately 10 cc q 2\n hrs drained, primary language Portuguese ([**Location 4808**]), CPP\ns > 70\n mmHg.\n CV: Sinus bradycardia to sinus rhythm in 50\ns and 60\ns, systolic blood\n pressure 140-160 mmHg, palpable pedal pulses, skin is warm and dry, PIV\n obtained for access.\n Resp: Clear upper lobes and diminished lower lobes upon auscultation,\n o2 sats > 95% on room air, normal respiratory rate and depth, strong\n non-productive cough.\n Endo: Regular insulin sliding scale with no coverage provided.\n Skin: EVD site clean dry and intact with sterile dressing, R forearm\n infiltration site soft with no erythema and no excessive heat noted,\n normal perfusion to hand, no s/s of compartment syndrome.\n GI: Advance to a regular diet with active bowel sounds and no nausea or\n vomiting.\n GU: Foley catheter with clear yellow urine production in adequate\n amounts, saline locked IV with adequate PO intake.\n MS: Minimal assistance x 1 to transfer to chair.\n Social: Has wife, children, and friends, sister in law work for [**Hospital1 1**].\n Plan: transfer to [**Hospital Ward Name 408**] 11 Step Down unit for q 2 hr neurological\n assessments and maintenance of EVD.\n Demographics\n Attending MD:\n [**First Name8 (NamePattern2) **] [**Doctor Last Name 1101**] C.\n Admit diagnosis:\n HYDROCEPHALUS/VP MALFUNTION\n Code status:\n Full code\n Height:\n Admission weight:\n 82.3 kg\n Daily weight:\n Allergies/Reactions:\n Lisinopril (Oral)\n palpitations;\n Precautions: Contact\n PMH:\n CV-PMH: Hypertension\n Additional history: Neurocysticercosis (pork tapeworm infection) with\n Crani in [**2115**] for removal of parasitic cyst in L ventricle then in [**2124**]\n VP shunt placed for hydrocephalus c/o by menengitis. [**8-/2124**] shunt\n revision done.\n other PMHx includes Hyperlipidemia, vertigo, anxiety, seizure disorder.\n Surgery / Procedure and date: [**2115**] cyst removal in 4th ventricle\n [**5-9**] VP shunt placed\n [**8-9**] Shunt revision\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:144\n D:88\n Temperature:\n 99.4\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 16 insp/min\n Heart Rate:\n 61 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n None\n O2 saturation:\n 97% %\n O2 flow:\n 2 L/min\n FiO2 set:\n 24h total in:\n 1,660 mL\n 24h total out:\n 2,102 mL\n Pertinent Lab Results:\n Sodium:\n 140 mEq/L\n [**2129-3-20**] 02:23 AM\n Potassium:\n 3.9 mEq/L\n [**2129-3-20**] 02:23 AM\n Chloride:\n 104 mEq/L\n [**2129-3-20**] 02:23 AM\n CO2:\n 27 mEq/L\n [**2129-3-20**] 02:23 AM\n BUN:\n 13 mg/dL\n [**2129-3-20**] 02:23 AM\n Creatinine:\n 1.1 mg/dL\n [**2129-3-20**] 02:23 AM\n Glucose:\n 96 mg/dL\n [**2129-3-20**] 02:23 AM\n Hematocrit:\n 36.9 %\n [**2129-3-20**] 02:23 AM\n Finger Stick Glucose:\n 120\n [**2129-3-20**] 08:00 AM\n Valuables / Signature\n Patient valuables:\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry:\n Transferred from: [**Hospital 450**]\n Transferred to: [**Wardname **]\n Date & time of Transfer: [**2129-3-20**] 12:00 AM\n",
+ "orig_doc_2": "SICU\n HPI:\n 57M w/ h/o cysticercosis s/p resection of 4th ventricle cyst, p/w\n dizziness -> hydrocephalus, now s/p EVD (opening pressure 15).\n Chief complaint:\n Dizziness/HA\n PMHx:\n neurocysticercosis, HA, HTN, dyslipidemia, sz d/o\n PSH: resection of 4th ventricular cyst, VP shunt placement ([**5-9**]) and\n revision ([**8-9**])\n Current medications:\n 1. 1000 mL NS 2. Acetaminophen w/Codeine 3. Acyclovir 4. Atorvastatin\n 5. CeftazIDIME 6. Docusate Sodium (Liquid)\n 7. Famotidine 8. Heparin 9. HydrALAzine 10. Insulin 11. LeVETiracetam\n 12. Magnesium Sulfate 13. Potassium Chloride\n 14. Senna 15. Vancomycin\n 24 Hour Events:\n no acute events.EEG performed\n Allergies:\n Lisinopril (Oral)\n palpitations;\n Last dose of Antibiotics:\n Acyclovir - [**2129-3-19**] 09:01 PM\n Vancomycin - [**2129-3-20**] 12:00 AM\n Ceftazidime - [**2129-3-20**] 02:20 AM\n Infusions:\n Other ICU medications:\n Famotidine (Pepcid) - [**2129-3-20**] 12:00 AM\n Heparin Sodium (Prophylaxis) - [**2129-3-20**] 12:00 AM\n Other medications:\n Flowsheet Data as of [**2129-3-20**] 04:04 AM\n Vital signs\n Hemodynamic monitoring\n Fluid balance\n 24 hours\n Since [**32**] a.m.\n Tmax: 38.3\nC (100.9\n T current: 37.6\nC (99.6\n HR: 57 (53 - 70) bpm\n BP: 144/90(103) {121/68(59) - 154/97(107)} mmHg\n RR: 14 (10 - 17) insp/min\n SPO2: 94%\n Heart rhythm: SB (Sinus Bradycardia)\n ICP: 10 (3 - 12) mmHg\n Total In:\n 3,237 mL\n 510 mL\n PO:\n Tube feeding:\n IV Fluid:\n 3,237 mL\n 510 mL\n Blood products:\n Total out:\n 1,422 mL\n 557 mL\n Urine:\n 1,154 mL\n 535 mL\n NG:\n 100 mL\n Stool:\n Drains:\n 168 mL\n 22 mL\n Balance:\n 1,815 mL\n -47 mL\n Respiratory support\n O2 Delivery Device: Nasal cannula\n SPO2: 94%\n ABG: ////\n Physical Examination\n General Appearance: No acute distress\n HEENT: PERRL\n Cardiovascular: (Rhythm: Regular), (Distant heart sounds: Present)\n Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: CTA\n bilateral : )\n Abdominal: Soft, Non-distended, Non-tender, Bowel sounds present\n Left Extremities: (Edema: Absent)\n Right Extremities: (Edema: Absent)\n Neurologic: Confused. No changes in Neuro exam\n Labs / Radiology\n 156 K/uL\n 12.8 g/dL\n 104 mg/dL\n 1.3 mg/dL\n 27 mEq/L\n 4.2 mEq/L\n 14 mg/dL\n 104 mEq/L\n 143 mEq/L\n 36.9 %\n 9.0 K/uL\n [image002.jpg]\n [**2129-3-19**] 01:07 AM\n [**2129-3-19**] 09:05 AM\n [**2129-3-19**] 06:19 PM\n [**2129-3-20**] 02:23 AM\n WBC\n 12.0\n 9.0\n Hct\n 43.1\n 36.9\n Plt\n 178\n 156\n Creatinine\n 1.3\n Troponin T\n <0.01\n <0.01\n <0.01\n Glucose\n 104\n Other labs: PT / PTT / INR:16.0/44.0/1.4, CK / CK-MB / Troponin\n T:157/1/<0.01, ALT / AST:30/18, Alk-Phos / T bili:64/0.3, Amylase /\n Lipase:/164, Lactic Acid:2.6 mmol/L, Albumin:4.4 g/dL, LDH:181 IU/L,\n Ca:9.4 mg/dL, Mg:1.7 mg/dL, PO4:4.6 mg/dL\n Assessment and Plan\n [**Last Name **] PROBLEM - ENTER DESCRIPTION IN COMMENTS\n Assessment and Plan: 56 yo male with VPS x 2 p/w headache\n NEURO: Shunt failure v. meningitis v. partial complex sz. EVD @ 10 but\n MS not improved p placement. Empiric abx. EEG. Keppra. F/u NS as may\n require further intervention\n CVS: SBP 140-160. Hydral prn SBP>170. Home statin. CE negative.\n PULM: No issues.\n GI: NPO for now. ?Speech and Swallow, if no planned interventions,\n advance diet as toloerated\n RENAL: Follow UOP. F/u Cr\n HEME: Hct stable.\n ENDO: RISS, Goal FS <150\n ID: F/u cx. Acyclovir, vanc/ceftaz continue for 48 hours, when final Cx\n negative, can d/c\n Lines / Tubes / Drains: Foley\n Fluids: NS\n Consults: Neuro surgery\n Billing Diagnosis: Other: ? increased ICP\n ICU Care\n Nutrition:\n Glycemic Control: Regular insulin sliding scale\n Lines:\n 18 Gauge - [**2129-3-19**] 09:00 AM\n 20 Gauge - [**2129-3-19**] 09:30 PM\n Prophylaxis:\n DVT: Boots, SQ UF Heparin\n Stress ulcer: H2 blocker\n VAP bundle:\n Comments:\n Communication: Comments:\n Code status: Full code\n Disposition: Transfer to floor\n Total time spent: 31 minutes\n",
+ "timestamp_1": "2129-03-20 14:45:00",
+ "timestamp_2": "2129-03-20 04:05:00",
+ "created_at": "2025-09-18T10:40:13.533972"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two notes create a direct conflict: Document 1 records a “non‑productive cough,” while Document 2 inserts a “productive cough with yellow sputum.” Temporally, neither note provides a clear timestamp, so the discrepancy cannot be resolved by time‑stamping. Semantically, “non‑productive” and “productive” are opposites, making the statements mutually exclusive. Physiologically both cough types are plausible in a neuro‑critical patient (e.g., aspiration vs. infection), but the clinical chain (hydrocephalus/EVD) does not explain an abrupt switch without an intervening event (e.g., pneumonia). Realistic reconciliation would require a timeline or a qualifier (e.g., “now productive”). The conflict is therefore realistic but poorly contextualized. \n\n**Score: 4**",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 845,
+ "end": 866,
+ "text": "non-productive cough.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two notes create a direct conflict: Document 1 records a “non‑productive cough,” while Document 2 inserts a “productive cough with yellow sputum.” Temporally, neither note provides a clear timestamp, so the discrepancy cannot be resolved by time‑stamping. Semantically, “non‑productive” and “productive” are opposites, making the statements mutually exclusive. Physiologically both cough types are plausible in a neuro‑critical patient (e.g., aspiration vs. infection), but the clinical chain (hydrocephalus/EVD) does not explain an abrupt switch without an intervening event (e.g., pneumonia). Realistic reconciliation would require a timeline or a qualifier (e.g., “now productive”). The conflict is therefore realistic but poorly contextualized. \n\n**Score: 4**",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 695,
+ "end": 764,
+ "text": "Allergies:The patient exhibits a productive cough with yellow sputum.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIF is +80 cmH2O (positive pressure), while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "orig_doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "orig_doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "timestamp_1": "2146-10-31 19:33:00",
+ "timestamp_2": "2146-11-01 04:55:00",
+ "created_at": "2025-09-18T10:40:34.600529"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents refer to the same encounter (date 2146‑10‑31), so temporally they should agree; however, they report opposite NIF values—‑49 cmH₂O (a physiologic negative inspiratory force) versus +80 cmH₂O (an implausible positive pressure reading). Semantically, “NIF” denotes maximal inspiratory pressure, always negative; the second record mis‑normalizes the term. The ‑49 cmH₂O aligns with moderate inspiratory effort in asthma, while +80 cmH₂O contradicts known physiology and the described restrictive flare‑up. Clinically, the treatment plan (high‑dose albuterol) fits the first value but not the second. A realistic reconciliation would flag the +80 cm H₂O as a documentation error and retain the ‑49 cm H₂O value. \n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 1876,
+ "end": 1890,
+ "text": "NIF: -49 cmH2O",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents refer to the same encounter (date 2146‑10‑31), so temporally they should agree; however, they report opposite NIF values—‑49 cmH₂O (a physiologic negative inspiratory force) versus +80 cmH₂O (an implausible positive pressure reading). Semantically, “NIF” denotes maximal inspiratory pressure, always negative; the second record mis‑normalizes the term. The ‑49 cmH₂O aligns with moderate inspiratory effort in asthma, while +80 cmH₂O contradicts known physiology and the described restrictive flare‑up. Clinically, the treatment plan (high‑dose albuterol) fits the first value but not the second. A realistic reconciliation would flag the +80 cm H₂O as a documentation error and retain the ‑49 cm H₂O value. \n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 242,
+ "end": 278,
+ "text": "NIF is +80 cmH2O (positive pressure)",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n Physical examination: left lung is absent.\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "orig_doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "orig_doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "timestamp_1": "2146-10-31 19:33:00",
+ "timestamp_2": "2146-11-01 04:55:00",
+ "created_at": "2025-09-18T10:40:38.385175"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents describe mutually exclusive pulmonary findings at the same encounter: Document 1 states “Physical examination: left lung is absent,” implying a missing left lung (pneumonectomy or agenesis), while Document 2 records audible left‑upper‑lobe (LUL) and left‑lower‑lobe (LLL) breath sounds with wheeze and clear areas. This violates temporal compatibility (both refer to the same visit), semantic normalization (both use standard lung‑exam terminology), physiological plausibility (a lung cannot be both absent and auscultated), and clinical chain plausibility (treatment decisions based on wheeze would be impossible if the lung were absent). The conflict is therefore realistic and well‑crafted, though the description of conflict 2 (“replaced … with the same text”) is vague, slightly weakening the overall presentation.\n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 1936,
+ "end": 1981,
+ "text": " Physical examination: left lung is absent.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents describe mutually exclusive pulmonary findings at the same encounter: Document 1 states “Physical examination: left lung is absent,” implying a missing left lung (pneumonectomy or agenesis), while Document 2 records audible left‑upper‑lobe (LUL) and left‑lower‑lobe (LLL) breath sounds with wheeze and clear areas. This violates temporal compatibility (both refer to the same visit), semantic normalization (both use standard lung‑exam terminology), physiological plausibility (a lung cannot be both absent and auscultated), and clinical chain plausibility (treatment decisions based on wheeze would be impossible if the lung were absent). The conflict is therefore realistic and well‑crafted, though the description of conflict 2 (“replaced … with the same text”) is vague, slightly weakening the overall presentation.\n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 69,
+ "end": 94,
+ "text": " LUL Lung Sounds: Clear",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to Current SpO2 measured at 92%.\n continue with treatments as tolerated.\n",
+ "orig_doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "orig_doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "timestamp_1": "2146-10-31 19:33:00",
+ "timestamp_2": "2146-11-01 04:55:00",
+ "created_at": "2025-09-18T10:40:41.475520"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents present contradictory oxygen‑saturation values: Document 1 records SpO₂ = 100 % (vital‑sign block dated 2146‑10‑31 07:02 PM), while Document 2 inserts “Current SpO₂ measured at 92 %” after the plan without a timestamp. Temporal compatibility is weak because no clear time difference is given; both appear to describe the same encounter. Semantic normalization is consistent (same metric). A drop from 100 % to 92 % is physiologically plausible in an asthmatic flare, but the clinical chain would usually trigger escalated therapy, which is not reflected. A realistic reconciliation would note the measurements were taken at different moments or clarify a transcription error, making the conflict acceptable yet improvable.\n\nScore: 5",
+ "conflict_type": "value",
+ "value": {
+ "start": 1309,
+ "end": 1319,
+ "text": "SpO2: 100%",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents present contradictory oxygen‑saturation values: Document 1 records SpO₂ = 100 % (vital‑sign block dated 2146‑10‑31 07:02 PM), while Document 2 inserts “Current SpO₂ measured at 92 %” after the plan without a timestamp. Temporal compatibility is weak because no clear time difference is given; both appear to describe the same encounter. Semantic normalization is consistent (same metric). A drop from 100 % to 92 % is physiologically plausible in an asthmatic flare, but the clinical chain would usually trigger escalated therapy, which is not reflected. A realistic reconciliation would note the measurements were taken at different moments or clarify a transcription error, making the conflict acceptable yet improvable.\n\nScore: 5",
+ "conflict_type": "value",
+ "value": {
+ "start": 335,
+ "end": 372,
+ "text": "Plan to Current SpO2 measured at 92%.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs and intravenous ampicillin. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "orig_doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "orig_doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "timestamp_1": "2146-10-31 19:33:00",
+ "timestamp_2": "2146-11-01 04:55:00",
+ "created_at": "2025-09-18T10:40:44.807774"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same encounter: a 25‑year‑old woman with myasthenia and asthma. Document 1 lists a penicillin allergy, while Document 2 states she is receiving intravenous ampicillin (a penicillin). The conflict is temporally compatible (same admission), semantically clear (allergy vs drug administration), physiologically plausible (administering a known allergen could cause an adverse reaction), and clinically implausible without justification (no desensitization noted). A realistic reconciliation would require either correcting the allergy entry, changing the antibiotic, or documenting a desensitization protocol. The conflict is well‑crafted, realistic, and highlights a genuine safety issue.\n\n**Score: 5**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 567,
+ "end": 578,
+ "text": "Penicillins",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same encounter: a 25‑year‑old woman with myasthenia and asthma. Document 1 lists a penicillin allergy, while Document 2 states she is receiving intravenous ampicillin (a penicillin). The conflict is temporally compatible (same admission), semantically clear (allergy vs drug administration), physiologically plausible (administering a known allergen could cause an adverse reaction), and clinically implausible without justification (no desensitization noted). A realistic reconciliation would require either correcting the allergy entry, changing the antibiotic, or documenting a desensitization protocol. The conflict is well‑crafted, realistic, and highlights a genuine safety issue.\n\n**Score: 5**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 129,
+ "end": 205,
+ "text": "Pt receiving high dose albuterol continuous nebs and intravenous ampicillin.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\nCurrent respiratory rate is 24 breaths per minute.\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "orig_doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "orig_doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "timestamp_1": "2146-10-31 19:33:00",
+ "timestamp_2": "2146-11-01 04:55:00",
+ "created_at": "2025-09-18T10:40:48.102250"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present conflicting respiratory rates: the flowsheet in Document 1 records RR 16 breaths/min (taken 07:02 PM on 2146‑10‑31), while Document 2 inserts a statement that the “current respiratory rate is 24 breaths/min.” Both use the same units, so semantic normalization is fine, and each value is physiologically plausible. However, the lack of an explicit timestamp in Document 2 makes temporal compatibility unclear; without a clear time cue the contradiction appears unrealistic for a single snapshot. Clinically, a rise from 16 to 24 could occur with worsening asthma and albuterol therapy, so the conflict could be reconciled if a time shift were noted, but the modification does not provide that context, reducing realism.\n\nScore: 4",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 1277,
+ "end": 1305,
+ "text": " RR: 16 (11 - 23) insp/min",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents present conflicting respiratory rates: the flowsheet in Document 1 records RR 16 breaths/min (taken 07:02 PM on 2146‑10‑31), while Document 2 inserts a statement that the “current respiratory rate is 24 breaths/min.” Both use the same units, so semantic normalization is fine, and each value is physiologically plausible. However, the lack of an explicit timestamp in Document 2 makes temporal compatibility unclear; without a clear time cue the contradiction appears unrealistic for a single snapshot. Clinically, a rise from 16 to 24 could occur with worsening asthma and albuterol therapy, so the conflict could be reconciled if a time shift were noted, but the modification does not provide that context, reducing realism.\n\nScore: 4",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 95,
+ "end": 176,
+ "text": " LLL Lung Sounds: Exp Wheeze\nCurrent respiratory rate is 24 breaths per minute.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "doc_2": "Lung sounds\n RLL Lung Sounds: Exp WheezeThe patient is febrile with a temperature of 38.5 °C (101.3 °F).\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "orig_doc_1": "Chief Complaint: dyspnea, resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 25 yr old woman with mysethenia and asthma presents with 10 days of URI\n symptoms. Her son had been ill and she thought this was simple URI but\n over past few days felt more like asthma.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Penicillins\n Rash;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Heparin Sodium (Prophylaxis) - [**2146-10-31**] 04:46 PM\n Other medications:\n Past medical history:\n Family history:\n Social History:\n Myesthenia\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Flowsheet Data as of [**2146-10-31**] 07:02 PM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.8\nC (98.3\n Tcurrent: 36.4\nC (97.6\n HR: 66 (58 - 71) bpm\n BP: 129/79(88) {120/78(86) - 135/84(101)} mmHg\n RR: 16 (11 - 23) insp/min\n SpO2: 100%\n Total In:\n 200 mL\n PO:\n 200 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 0 mL\n Urine:\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n 200 mL\n Respiratory\n O2 Delivery Device: None\n SpO2: 100%\n ABG: ////\n NIF: -49 cmH2O\n Physical Examination\n Gen: young woman,\n HEENT: nystagmus with extreme left and right extreme gaze\n CV: RR\n Chest: fair\n Abd:soft NT + BS\n Ext: no edema\n Neuro: a and o x 3, ptosis, nystagmus wuth extreme lateral gaze,\n Labs / Radiology\n 290\n 40.5\n 0.7\n 12\n 20\n 106\n 3.7\n 137\n 6.2\n [image002.jpg]\n Assessment and Plan\n 25 yr old woman with myesthenia and asthma presents with URIO and\n asthma exacrebation leading to resp distress which may be evolving\n myesthenic crisis in setting of significantly work of breathing.\n 1. Myesthenia: Severe course in the past yeasr requiring intubation x\n 2, now with vital capacity of 1 liter and NIF -50. Our concern is that\n she is beginning to tire out. We are treating with steroids and\n increased mestinon. Follow\n Q2 NIF, VC, and check ABG for occult hypercarbia. If requires, NIF\n approaches 25 or VC dropping less than 1 liter we will plan for\n elective intubation. Would try to avoid paralytics.\n 2. Asthma: nebs, steroids\n will switch to IV, no role for ABX at\n present\n 3. GERD: ppi\n ICU Care\n Nutrition: NPO given tenuous resp status\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2146-10-31**] 02:38 PM\n Prophylaxis:\n DVT: sc hep\n Stress ulcer:\n Communication: with pt\n [**Name (NI) 66**] status: Full code\n Disposition: ICU\n Total time spent: 45\n",
+ "orig_doc_2": "Lung sounds\n RLL Lung Sounds: Exp Wheeze\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Exp Wheeze\n Pt receiving high dose albuterol continuous nebs. BS improving. Peak\n flows 300-350, ( her personal best 450). NIFs in the 80s, while vital\n capacity hard to obtain due to restrictive disease flare up. Plan to\n continue with treatments as tolerated.\n",
+ "timestamp_1": "2146-10-31 19:33:00",
+ "timestamp_2": "2146-11-01 04:55:00",
+ "created_at": "2025-09-18T10:40:56.374438"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents describe the same patient encounter but report incompatible core vital signs: Document 1’s flowsheet records a maximum temperature of 36.8 °C (98.3 °F), while Document 2 inserts a statement that the patient is febrile with a temperature of 38.5 °C (101.3 °F). The conflict is semantically clear (temperature units are normalized) and physiologically plausible as a fever could develop, yet the lack of a distinct timestamp makes the temporal compatibility ambiguous, reducing realism. Overall, the contradiction is well‑formed and realistic for a clinical scenario, though the reconciliation (e.g., indicating a later time) is missing.\n\nScore: 4",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 1158,
+ "end": 1168,
+ "text": "Tmax: 36.8",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two documents describe the same patient encounter but report incompatible core vital signs: Document 1’s flowsheet records a maximum temperature of 36.8 °C (98.3 °F), while Document 2 inserts a statement that the patient is febrile with a temperature of 38.5 °C (101.3 °F). The conflict is semantically clear (temperature units are normalized) and physiologically plausible as a fever could develop, yet the lack of a distinct timestamp makes the temporal compatibility ambiguous, reducing realism. Overall, the contradiction is well‑formed and realistic for a clinical scenario, though the reconciliation (e.g., indicating a later time) is missing.\n\nScore: 4",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 15,
+ "end": 106,
+ "text": "RLL Lung Sounds: Exp WheezeThe patient is febrile with a temperature of 38.5 °C (101.3 °F).",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. No abdominal drains are present. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "orig_doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "orig_doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "timestamp_1": "2137-09-07 02:18:00",
+ "timestamp_2": "2137-09-04 18:46:00",
+ "created_at": "2025-09-18T10:41:39.055977"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two reports describe the same post‑liver‑transplant patient within a few days of each other. Document 1 notes “several drains on the right” in the abdomen, while Document 2 explicitly states “No abdominal drains are present.” This creates a direct semantic conflict about drain presence. Temporally the reports are compatible (within ≈ 1 day), making the contradiction plausible if a drain had been removed, but Document 2 also mentions “replacing volume of lateral drain loss,” which re‑introduces a drain, further deepening the inconsistency. The conflict is clinically relevant, physiologically plausible, and realistic for a validation task, and it is clearly articulated.\n\n**Score: 5**",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 155,
+ "end": 185,
+ "text": "Reason: central line placement",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two reports describe the same post‑liver‑transplant patient within a few days of each other. Document 1 notes “several drains on the right” in the abdomen, while Document 2 explicitly states “No abdominal drains are present.” This creates a direct semantic conflict about drain presence. Temporally the reports are compatible (within ≈ 1 day), making the contradiction plausible if a drain had been removed, but Document 2 also mentions “replacing volume of lateral drain loss,” which re‑introduces a drain, further deepening the inconsistency. The conflict is clinically relevant, physiologically plausible, and realistic for a validation task, and it is clearly articulated.\n\n**Score: 5**",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 1143,
+ "end": 1175,
+ "text": "No abdominal drains are present.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear and lung volumes are within normal limits. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "orig_doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "orig_doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "timestamp_1": "2137-09-07 02:18:00",
+ "timestamp_2": "2137-09-04 18:46:00",
+ "created_at": "2025-09-18T10:41:46.214300"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two reports describe opposing pulmonary status: the radiology note (Document 1) reports low lung volumes, mild congestive failure and basilar atelectasis, whereas the clinical note (Document 2) explicitly states “lungs clear and lung volumes are within normal limits.” Both pertain to the same postoperative period, so the temporal context matches, but the semantic content is contradictory, making the physiological and clinical chains implausible if taken simultaneously. This creates a clear, realistic conflict that could be reconciled only by invoking differing assessment times or imaging modalities, which the documents do not specify. \n\nScore: 5",
+ "conflict_type": "value",
+ "value": {
+ "start": 1096,
+ "end": 1150,
+ "text": "Lungs clear and lung volumes are within normal limits.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation. (Note: contraindicated due to end‑stage liver disease)\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "orig_doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "orig_doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "timestamp_1": "2137-09-07 02:18:00",
+ "timestamp_2": "2137-09-04 18:46:00",
+ "created_at": "2025-09-18T10:41:52.573070"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents refer to the same underlying condition—end‑stage liver disease—creating a direct factual tension: the chest‑port report (Doc 1) lists it as the admitting diagnosis, while the postoperative note (Doc 2) flags Percocet as “contraindicated due to end‑stage liver disease.” The temporal frames overlap (both pertain to the early post‑transplant period), the terminology is consistent, the physiological claim that opioid metabolism is impaired in severe hepatic failure is medically sound, and the clinical decision chain (avoiding a hepatically‑metabolized opioid) follows standard transplant pain‑management practice. The conflict is realistic, coherent, and reconcilable by acknowledging the contraindication in the pain‑control plan.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 187,
+ "end": 231,
+ "text": "Admitting Diagnosis: END STAGE LIVER DISEASE",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents refer to the same underlying condition—end‑stage liver disease—creating a direct factual tension: the chest‑port report (Doc 1) lists it as the admitting diagnosis, while the postoperative note (Doc 2) flags Percocet as “contraindicated due to end‑stage liver disease.” The temporal frames overlap (both pertain to the early post‑transplant period), the terminology is consistent, the physiological claim that opioid metabolism is impaired in severe hepatic failure is medically sound, and the clinical decision chain (avoiding a hepatically‑metabolized opioid) follows standard transplant pain‑management practice. The conflict is realistic, coherent, and reconcilable by acknowledging the contraindication in the pain‑control plan.\n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 807,
+ "end": 931,
+ "text": " Possible switch to Percocets for longer effect with less sedation. (Note: contraindicated due to end‑stage liver disease)",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.There is no interval development of congestive failure; cardiac status remains unchanged.\n",
+ "orig_doc_1": "[**2137-9-7**] 2:18 AM\n CHEST PORT. LINE PLACEMENT; -76 BY SAME PHYSICIAN [**Name Initial (PRE) 73**] # [**Clip Number (Radiology) 91472**]\n Reason: central line placement\n Admitting Diagnosis: END STAGE LIVER DISEASE\n ______________________________________________________________________________\n [**Hospital 4**] MEDICAL CONDITION:\n 56 year old man s/p liver transplant\n REASON FOR THIS EXAMINATION:\n central line placement\n ______________________________________________________________________________\n FINAL REPORT\n PORTABLE LINE PLACEMENT. CHEST [**2137-9-7**]\n\n CLINICAL INFORMATION: Central line placement.\n\n COMPARISON STUDY: [**2137-9-6**].\n\n FINDINGS:\n\n Since the prior study, there are low lung volumes with mild congestive failure\n as demonstrated by increased congestion of the central pulmonary vasculature.\n There is a right IJ catheter terminating at the cavoatrial junction. Surgical\n staples are present in the mid abdomen with several drain on the right. There\n is mild basilar atelectasis.\n\n Interval development of mild congestive failure.\n\n\n",
+ "orig_doc_2": "Pt presented from [**Hospital Ward Name 408**] 10 with concerns over lethargy, desaturation and\n questionable bile leak. He is 6 days post-op high risk liver transplant\n by Dr [**Last Name (STitle) 496**].\n Pain control (acute pain, chronic pain)\n Assessment:\n On [**Hospital Ward Name 408**] 10 RN report receiving dilaudid 1-2mg Q3h and had become very\n lethargic and desaturation into 80s. In ICU Pt complains of pain [**7-4**]\n in intensity, given 1mg dialudid with little response (pain 7) and\n repeated dose with better effect on pain however becomes very sleepy\n with RR 8-10 after 2mg dilaudid.\n Action:\n Given 1mg dilaudid at a time. Discussed with team changing to PO pain\n meds.\n Response:\n P still sleepy after 1mg dilaudid but is arousable and orientated.\n Plan:\n Possible switch to Percocets for longer effect with less sedation.\n Transplant, liver\n Assessment:\n CT chest and Abdomen done. Chest negative for PE and ? bile leak vs\n hematoma under R diaphragm per Transplant team. Pt afebrile, VSS. WBCs\n flat. ABGs wnl. Good sats on 2lnc. Lungs clear. Abdomen soft,\n distended, +BS. Lateral drain with large bilious output. Urine cx and\n blood cx x 2 sent. Unable to obtain sputum cx.\n Action:\n Aline placed per transplants request. Replacing\n volume of lateral\n drain volume loss.\n Response:\n VSS. Pt not showing signs of sepsis.\n Plan:\n Follow-up with transplant.\n",
+ "timestamp_1": "2137-09-07 02:18:00",
+ "timestamp_2": "2137-09-04 18:46:00",
+ "created_at": "2025-09-18T10:41:56.308378"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same postoperative liver‑transplant patient. Document 1 reports “Interval development of mild congestive failure,” while Document 2 explicitly inserts “There is no interval development of congestive failure; cardiac status remains unchanged.” The statements use identical terminology (congestive failure) and refer to the same time window (post‑op day 6), making the temporal and semantic overlap exact. Physiologically, a patient cannot simultaneously develop and not develop new congestion, so the conflict is implausible unless attributed to differing clinical assessments—a realistic source of disagreement in practice. The contradiction is clear, well‑structured, and reflects a plausible documentation error, satisfying the criteria for a high‑quality factual conflict. \n\nScore: 5",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 1406,
+ "end": 1530,
+ "text": "Plan:\n Follow-up with transplant.There is no interval development of congestive failure; cardiac status remains unchanged.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98% (recorded on arrival to the emergency department). Note: This measurement was taken at the same time as the 84% reading reported in Document 1, making the values directly comparable.\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "orig_doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "orig_doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "timestamp_1": "2122-07-19 14:46:00",
+ "timestamp_2": "2122-07-18 09:44:00",
+ "created_at": "2025-09-18T10:42:31.034980"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same patient’s arrival oxygen saturation, yet they report mutually exclusive values (84 % vs 98 %) for the identical time point. This creates a clear temporal incompatibility, violates semantic normalization (same metric, different result), and is physiologically implausible because a patient cannot simultaneously have two distinct saturations. Clinically, the discrepancy would affect immediate management (oxygen therapy, CPAP decisions), making the conflict highly relevant. The reconciliation note in Document 2 explicitly highlights the contradiction, which is realistic for documentation errors, thereby forming a well‑crafted factual conflict.\n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 287,
+ "end": 321,
+ "text": "In ER; Oxygen sats on arrival 84%.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same patient’s arrival oxygen saturation, yet they report mutually exclusive values (84 % vs 98 %) for the identical time point. This creates a clear temporal incompatibility, violates semantic normalization (same metric, different result), and is physiologically implausible because a patient cannot simultaneously have two distinct saturations. Clinically, the discrepancy would affect immediate management (oxygen therapy, CPAP decisions), making the conflict highly relevant. The reconciliation note in Document 2 explicitly highlights the contradiction, which is realistic for documentation errors, thereby forming a well‑crafted factual conflict.\n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 1762,
+ "end": 1954,
+ "text": "SpO2: 98% (recorded on arrival to the emergency department). Note: This measurement was taken at the same time as the 84% reading reported in Document 1, making the values directly comparable.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)Note: The bullous disease was not appreciated on physical examination.\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "orig_doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "orig_doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "timestamp_1": "2122-07-19 14:46:00",
+ "timestamp_2": "2122-07-18 09:44:00",
+ "created_at": "2025-09-18T10:42:33.738095"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nBoth documents describe the same 80‑year‑old patient at the same time point. Document 1 now states lung fields are clear with “no evidence of bullae or emphysematous changes,” while Document 2 explicitly records a “massive bullous emphysema” on imaging and adds a note that the bullous disease was not appreciated on physical exam. This creates a clear semantic clash (presence vs. absence of bullae) that is physiologically plausible—large bullae can be missed on auscultation—yet the definitive denial in Document 1 conflicts with the imaging finding. The temporal alignment is consistent, the terminology is normalized, and the discrepancy is realistic, making the conflict both acceptable and clinically credible. \n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 543,
+ "end": 665,
+ "text": "CXR: massive bullous emphy (old CT with huge bulla)Note: The bullous disease was not appreciated on physical examination.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total fluid intake recorded as 100 mL (24‑hour total). Note: This total intake corresponds to the same 24‑hour period as the 700 mL infusion reported in Document 1, creating a direct conflict.\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "orig_doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "orig_doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "timestamp_1": "2122-07-19 14:46:00",
+ "timestamp_2": "2122-07-18 09:44:00",
+ "created_at": "2025-09-18T10:42:42.949261"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents refer to the same 24‑hour period (July 2122) and both mention fluid management, providing a clear point of contention. Document 1 records a 700 mL D5W infusion, while Document 2 records a total fluid intake of only 100 mL and explicitly calls this “the same period,” creating a direct quantitative conflict. This clash is temporally compatible, semantically aligned (both fluid volume), physiologically plausible (both values could be recorded, but they cannot both be true), and fits the clinical picture of a critically ill, diuretic‑treated patient. However, *conflict 1* merely repeats the same sentence and does not introduce any real disagreement, weakening the overall conflict‑creation effort. Because the primary conflict is realistic and well‑structured but the first “conflict” is trivial, the overall quality is solid but not exemplary. \n\n**Score: 4**",
+ "conflict_type": "value",
+ "value": {
+ "start": 1872,
+ "end": 2064,
+ "text": "Total fluid intake recorded as 100 mL (24‑hour total). Note: This total intake corresponds to the same 24‑hour period as the 700 mL infusion reported in Document 1, creating a direct conflict.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered pulmicort (budesonide) nebulizer treatments. Note: Pulmicort was given despite known steroid allergy (Advair Diskus), representing a contraindication. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Allergy to Advair Diskus (fluticasone/salmeterol).\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "orig_doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "orig_doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "timestamp_1": "2122-07-19 14:46:00",
+ "timestamp_2": "2122-07-18 09:44:00",
+ "created_at": "2025-09-18T10:42:47.623839"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nBoth documents now state that the patient is allergic to Advair Diskus (fluticasone/salmeterol). Document 1 adds a medication error: Pulmicort (budesonide) was administered despite that known steroid allergy, creating a clear clinical conflict. Temporal compatibility is maintained (same admission window). Semantic normalization aligns the allergy terminology across texts. Physiologically, cross‑reactivity between inhaled steroids is plausible, making the error realistic. The clinical chain (CHF/COPD exacerbation → need for bronchodilator/steroid) supports the intended use of Pulmicort, while the allergy introduces a contraindication, yielding a believable discrepancy. A realistic reconciliation would note the error and recommend discontinuation or alternative therapy.\n\n**Score: 5**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 1588,
+ "end": 1751,
+ "text": "Administered pulmicort (budesonide) nebulizer treatments. Note: Pulmicort was given despite known steroid allergy (Advair Diskus), representing a contraindication.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nBoth documents now state that the patient is allergic to Advair Diskus (fluticasone/salmeterol). Document 1 adds a medication error: Pulmicort (budesonide) was administered despite that known steroid allergy, creating a clear clinical conflict. Temporal compatibility is maintained (same admission window). Semantic normalization aligns the allergy terminology across texts. Physiologically, cross‑reactivity between inhaled steroids is plausible, making the error realistic. The clinical chain (CHF/COPD exacerbation → need for bronchodilator/steroid) supports the intended use of Pulmicort, while the allergy introduces a contraindication, yielding a believable discrepancy. A realistic reconciliation would note the error and recommend discontinuation or alternative therapy.\n\n**Score: 5**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 720,
+ "end": 770,
+ "text": "Allergy to Advair Diskus (fluticasone/salmeterol).",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. This represents a decline from the 98% saturation recorded the previous day (see prior note). Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98% This was higher than the 84% saturation observed on the subsequent day.\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "orig_doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "orig_doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "timestamp_1": "2122-07-19 14:46:00",
+ "timestamp_2": "2122-07-18 09:44:00",
+ "created_at": "2025-09-18T10:42:51.065504"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The added sentences create a direct temporal clash: Document 1 claims the patient’s saturation fell from 98 % the day before admission to 84 % on arrival, while Document 2 states the 98 % reading occurred **after** an 84 % reading, implying the opposite trend. Semantic normalization is sound (both refer to SpO₂ %). The reversal is physiologically plausible—oxygenation can fluctuate—but the clinical timeline is inconsistent given the documented dates (7‑9 vs 7‑18). The chain of events (diuresis, CPAP, ICU stay) could accommodate both values if they belong to separate encounters, yet the conflict as written is unrealistic without clarification. A realistic reconciliation would note the dates explicitly or attribute the 98 % to a later reassessment. \n\nScore: 4",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 287,
+ "end": 415,
+ "text": "In ER; Oxygen sats on arrival 84%. This represents a decline from the 98% saturation recorded the previous day (see prior note).",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The added sentences create a direct temporal clash: Document 1 claims the patient’s saturation fell from 98 % the day before admission to 84 % on arrival, while Document 2 states the 98 % reading occurred **after** an 84 % reading, implying the opposite trend. Semantic normalization is sound (both refer to SpO₂ %). The reversal is physiologically plausible—oxygenation can fluctuate—but the clinical timeline is inconsistent given the documented dates (7‑9 vs 7‑18). The chain of events (diuresis, CPAP, ICU stay) could accommodate both values if they belong to separate encounters, yet the conflict as written is unrealistic without clarification. A realistic reconciliation would note the dates explicitly or attribute the 98 % to a later reassessment. \n\nScore: 4",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 1762,
+ "end": 1843,
+ "text": "SpO2: 98% This was higher than the 84% saturation observed on the subsequent day.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not Despite the earlier note of altered mental status, the patient now appears fully oriented.\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status The earlier assessment of orientation was not corroborated on re‑evaluation., LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "orig_doc_1": "80 yo female admitted from home after 4 days increasing dyspnea and\n pedal edema. She was just recently d/c\nd from the hospital where they\n had discontinued her home med lasix, due to rising creatinine. Pt\n complained her legs were\n swelling something awful\n since discharge.\n In ER; Oxygen sats on arrival 84%. Pt. given combivent x3, briefly on\n cpap in ER but arrives to MICU with 1-2 liters nasal cannula sats 95%.\n Ct head done due to confusion essentially neg.\n History COPD non oxygen dependant, dementia, gerd, AVR, recent admit\n [**2122-7-9**] for pancreatitis, non surgical candidate.\n Pleasant affect, oriented to person, place and time, but does not\n offer much conversation and is unable to state what she likes to eat,\n or what pills she takes at home. No attempts OOB today, but has on\n prior shifts, bed alarm maintained. Family states she has been living\n alone at home but pt. now states she would like to speak to social\n services regarding future disposition planning, social service\n consulted. Remains full code at this time.\n Dyspnea (Shortness of breath)\n Assessment:\n Received patient on 1 L NC, O2 sats 96%; LS clear in upper lobed and\n diminished in bilateral bases. Weak but productive cough into Kleenex.\n SOB with mild exertion including laying flat; pursed lip breathing. Has\n 2 + pitting pedal edema bilaterally. [**Name8 (MD) **] MD likely cause is a mixture\n of decompensated CHF & exacerbation of her underlying COPD. Patient\n with remote history of PNA resulting in loss of lung tissue.\n Action:\n Administered Ipratropium nebs as well as pulmicort nebs. Attempted\n weaning off O2 to RA. Diuresis with 20 mg po lasix. Awaiting family to\n bring in patient\ns home symbacort. Infusing 700 ml D5W at 100 ml/hr to\n treat hypernatermia.\n Response:\n Patients O2 sats dipped to 84 % on RA, but maintains sats > 90% on 1 L\n NC (goal is 88-92% given patients COPD). Mild output to po lasix,\n currently -875 since midnight (goal is even). Recent cardiac echo\n showed good EF and function of her AVR, also mild pulmonary HTN.\n Plan:\n Continue to wean O2 as tolerated,goal O2 sat 88-92%. Monitor I/O; goal\n negative, complete infusion of D5W at 100 ml/hr for 700 ml. Continue\n neb treatments; alert pharmacy when family brings in symbacort from\n home for approval. Monitor afternoon electrolytes, due at 5 pm.\n Delirium / confusion\n Assessment:\n Patient pleasant, and oriented to person, place & time, however she is\n unable to answer questions such as\nwhat would you like to eat\nwhat pills do you take at home\n. No attempts OOB with family present\n throughout the afternoon. Moderate-poor appetite per patient.\n Action:\n Attempted to engage patient in easy conversation. Discussed with family\n & accepting MD team the family\ns concerns about her returning to an\n independent living situation. Bed alarm maintained and call light\n available.\n Response:\n Continues without any attempts OOB & remains oriented, although\n pleasantly quiet. MD will obtain PT consult when medically ready prior\n to discharge. [**Name6 (MD) **] need RN case manager to assist patient and family\n with discharge planning when appropriate.\n Plan:\n Continue bed alarms. PT consult and RN case management follow-up prior\n to discharge. Monitor labs including renal function & for s/s infection\n which may cause confusion.\n Demographics\n Attending MD:\n [**Doctor Last Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]\n Admit diagnosis:\n COPD EXACERBATION\n Code status:\n Height:\n Admission weight:\n 66.7 kg\n Daily weight:\n 62.7 kg\n Allergies/Reactions:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Precautions:\n PMH: COPD\n CV-PMH: CAD, CHF\n Additional history: pancreatitis, rule out MI, aortic stenosis, AVR\n Surgery / Procedure and date: AVR\n Latest Vital Signs and I/O\n Non-invasive BP:\n S:131\n D:51\n Temperature:\n 97.9\n Arterial BP:\n S:\n D:\n Respiratory rate:\n 21 insp/min\n Heart Rate:\n 63 bpm\n Heart rhythm:\n SR (Sinus Rhythm)\n O2 delivery device:\n Nasal cannula\n O2 saturation:\n 94% %\n O2 flow:\n 1 L/min\n FiO2 set:\n 24h total in:\n 720 mL\n 24h total out:\n 1,595 mL\n Pertinent Lab Results:\n Sodium:\n 148 mEq/L\n [**2122-7-19**] 03:51 AM\n Potassium:\n 4.3 mEq/L\n [**2122-7-19**] 03:51 AM\n Chloride:\n 99 mEq/L\n [**2122-7-19**] 03:51 AM\n CO2:\n 41 mEq/L\n [**2122-7-19**] 03:51 AM\n BUN:\n 25 mg/dL\n [**2122-7-19**] 03:51 AM\n Creatinine:\n 1.4 mg/dL\n [**2122-7-19**] 03:51 AM\n Glucose:\n 97 mg/dL\n [**2122-7-19**] 03:51 AM\n Hematocrit:\n 30.8 %\n [**2122-7-19**] 03:51 AM\n Finger Stick Glucose:\n 199\n [**2122-7-19**] 10:00 AM\n Valuables / Signature\n Patient valuables: glasses with case and upper and lower dentures.\n Other valuables:\n Clothes: Sent home with:\n Wallet / Money:\n No money / wallet\n Cash / Credit cards sent home with:\n Jewelry: wearing wedding band\n Transferred from: MICU 6\n Transferred to: CC7\n Date & time of Transfer: [**2122-7-19**] at 1600\n",
+ "orig_doc_2": "Chief Complaint: acute resp distress\n I saw and examined the patient, and was physically present with the ICU\n Resident for key portions of the services provided. I agree with his /\n her note above, including assessment and plan.\n HPI:\n 80 yr old woman rpoesnets with altered mental status, LE swelling, and\n dyspnea.\n Recent admit 1 week ago - for gallbladder disease, Pulm eval flet high\n risk for R so surgery was deferred\n Started on Azithro, starte [**Male First Name (un) **] CPAP and sent to MICU for management.\n CXR: massive bullous emphy (old CT with huge bulla)\n Patient admitted from: [**Hospital1 54**] ER\n History obtained from [**Hospital 85**] Medical records\n Allergies:\n Advair Diskus (Inhalation) (Fluticasone/Salmeterol)\n Frequent coughi\n Verapamil\n Unknown;\n Solu-Medrol (Intraven) (Methylprednisolone Sod Succ)\n Unknown;\n Last dose of Antibiotics:\n Infusions:\n Other ICU medications:\n Furosemide (Lasix) - [**2122-7-18**] 02:00 AM\n Other medications:\n Colce, sq hep. Asa, levothyroxine, simva, metoprolol, atrovent,\n Past medical history:\n Family history:\n Social History:\n COPD -\n Occupation:\n Drugs:\n Tobacco:\n Alcohol:\n Other:\n Review of systems:\n Constitutional: Fatigue\n Cardiovascular: Edema\n Respiratory: Dyspnea, Tachypnea\n Heme / Lymph: Anemia\n Flowsheet Data as of [**2122-7-18**] 09:20 AM\n Vital Signs\n Hemodynamic monitoring\n Fluid Balance\n 24 hours\n Since 12 AM\n Tmax: 36.1\nC (97\n Tcurrent: 36.1\nC (97\n HR: 66 (62 - 72) bpm\n BP: 140/67(84) {122/49(69) - 148/67(84)} mmHg\n RR: 22 (16 - 22) insp/min\n SpO2: 98%\n Heart rhythm: SR (Sinus Rhythm)\n Wgt (current): 66.6 kg (admission): 66.7 kg\n Total In:\n 100 mL\n PO:\n 100 mL\n TF:\n IVF:\n Blood products:\n Total out:\n 0 mL\n 1,345 mL\n Urine:\n 1,345 mL\n NG:\n Stool:\n Drains:\n Balance:\n 0 mL\n -1,245 mL\n Respiratory\n O2 Delivery Device: Nasal cannula\n SpO2: 98%\n ABG: ///40/\n Physical Examination\n Gen: conversant, mild resp distress with movement\n HEENT: op dry\n CV: RR loud S2\n Chest: dimished BS apically, rare rales at bases\n Abd: mild RUQ pain to deep palp\n Ext: 3+ LE edema\n Labs / Radiology\n 202 K/uL\n 29.5 %\n 9.0 g/dL\n 105 mg/dL\n 1.3 mg/dL\n 25 mg/dL\n 40 mEq/L\n 102 mEq/L\n 4.2 mEq/L\n 147 mEq/L\n 6.7 K/uL\n [image002.jpg]\n [**2122-7-18**] 04:59 AM\n WBC\n 6.7\n Hct\n 29.5\n Plt\n 202\n Cr\n 1.3\n TropT\n <0.01\n Glucose\n 105\n Other labs: PT / PTT / INR:12.5/24.3/1.0, CK / CKMB /\n Troponin-T:33//<0.01, ALT / AST:13/14, Alk Phos / T Bili:48/0.3, Lactic\n Acid:1.0 mmol/L, LDH:200 IU/L, Ca++:8.7 mg/dL, Mg++:2.2 mg/dL, PO4:3.6\n mg/dL\n Assessment and Plan\n DYSPNEA (SHORTNESS OF BREATH)\n DELIRIUM / CONFUSION\n 1. Acute Resp Distress w hypercarbia: initial DDX was amix of\n decompensated heart failure and excarebation of her underlying COPD.\n She responded well to NIPPV, lasix, and nebs. Currently on nasal canula\n this AM\n 2. Sys CHF: checking Echo in light of AVR which has not been\n foloowed since [**2119**] to assess for valvular compotenecy and will also\n look at PA pressure and RV dysfn.\n 3. CRI: DDx is pre renal\n they had stooped her diuretics and she\n failed that exp.\n likely poor forward flow in CHF. She has actually\n had Cr come down with diuresis so would ocnitnue goal negative 500 as\n terates watch UOP and CR closely\n Remaining issues as per Housestaff\n ICU Care\n Nutrition: advance diet\n Glycemic Control:\n Lines / Intubation:\n 20 Gauge - [**2122-7-17**] 10:36 PM\n Comments:\n Prophylaxis:\n DVT:\n Stress ulcer:\n Communication: with pt and daughter\n [**Name (NI) 66**] status: FULL\n though she had stated she would not want long term\n intubation\n Disposition: call out\n Total time spent: 35\n",
+ "timestamp_1": "2122-07-19 14:46:00",
+ "timestamp_2": "2122-07-18 09:44:00",
+ "created_at": "2025-09-18T10:42:54.687957"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two insertions create a direct, clinically plausible contradiction about the patient’s mental status: Document 1 states the patient “now appears fully oriented” after an earlier note of altered mental status, while Document 2 claims “the earlier assessment of orientation was not corroborated on re‑evaluation,” implying the patient remained disoriented. This conflict is temporally compatible (both refer to the same admission), semantically opposite but reconcilable by noting a rapid change in cognition, physiologically possible in delirium, and fits the clinical chain (orientation influences management). The conflict is realistic and can be resolved with a clarifying timeline, meeting all evaluation dimensions.\n\nScore: 5",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 618,
+ "end": 774,
+ "text": "Pleasant affect, oriented to person, place and time, but does not Despite the earlier note of altered mental status, the patient now appears fully oriented.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two insertions create a direct, clinically plausible contradiction about the patient’s mental status: Document 1 states the patient “now appears fully oriented” after an earlier note of altered mental status, while Document 2 claims “the earlier assessment of orientation was not corroborated on re‑evaluation,” implying the patient remained disoriented. This conflict is temporally compatible (both refer to the same admission), semantically opposite but reconcilable by noting a rapid change in cognition, physiologically possible in delirium, and fits the clinical chain (orientation influences management). The conflict is realistic and can be resolved with a clarifying timeline, meeting all evaluation dimensions.\n\nScore: 5",
+ "conflict_type": "descriptive",
+ "value": {
+ "start": 280,
+ "end": 378,
+ "text": "altered mental status The earlier assessment of orientation was not corroborated on re‑evaluation.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n Right lower lobe lung sounds are diminished.\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n Right lower lobe lung sounds are clear.\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "timestamp_1": "2114-08-07 04:37:00",
+ "timestamp_2": "2114-08-05 06:01:00",
+ "created_at": "2025-09-18T10:43:10.723555"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents present opposite findings for the right‑lower‑lobe lung sounds (diminished vs clear). Temporal compatibility is maintained because the ventilation days differ (18 vs 16), allowing a plausible clinical evolution. Semantic normalization shows the same wording was swapped, preserving lexical consistency while creating a factual contradiction. Physiologically, a patient’s lung sounds can improve or worsen over a couple of days, so both statements are plausible individually. Clinically, the surrounding data (different sputum characteristics, tracheostomy tube type) support a realistic change in respiratory status, making the conflict credible. Thus the conflict is both acceptable and realistic.\n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 798,
+ "end": 842,
+ "text": "Right lower lobe lung sounds are diminished.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents present opposite findings for the right‑lower‑lobe lung sounds (diminished vs clear). Temporal compatibility is maintained because the ventilation days differ (18 vs 16), allowing a plausible clinical evolution. Semantic normalization shows the same wording was swapped, preserving lexical consistency while creating a factual contradiction. Physiologically, a patient’s lung sounds can improve or worsen over a couple of days, so both statements are plausible individually. Clinically, the surrounding data (different sputum characteristics, tracheostomy tube type) support a realistic change in respiratory status, making the conflict credible. Thus the conflict is both acceptable and realistic.\n\nScore: 5",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 796,
+ "end": 835,
+ "text": "Right lower lobe lung sounds are clear.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: StandardThe tracheostomy tube type is Standard.\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: CuffedTracheostomy tube type is cuffed.\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "timestamp_1": "2114-08-07 04:37:00",
+ "timestamp_2": "2114-08-05 06:01:00",
+ "created_at": "2025-09-18T10:43:13.918945"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same patient’s airway but contradict on the tracheostomy tube type (Standard vs Cuffed) while keeping other parameters identical (manufacturer, size, cuff pressure). The discrepancy is temporally compatible (different ventilation days) and semantically clear, making the conflict realistic: a cuffed tube would affect airway pressures and secretion management, which aligns with the differing sputum colors and lung‑sound findings. Clinically, such a mismatch could arise from documentation error or a change in tube type, so the conflict is plausible and reconcilable. The modifications therefore create a well‑structured, realistic conflict across all evaluation dimensions. \n\nScore: 5",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 438,
+ "end": 491,
+ "text": "Type: StandardThe tracheostomy tube type is Standard.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "Both documents describe the same patient’s airway but contradict on the tracheostomy tube type (Standard vs Cuffed) while keeping other parameters identical (manufacturer, size, cuff pressure). The discrepancy is temporally compatible (different ventilation days) and semantically clear, making the conflict realistic: a cuffed tube would affect airway pressures and secretion management, which aligns with the differing sputum colors and lung‑sound findings. Clinically, such a mismatch could arise from documentation error or a change in tube type, so the conflict is plausible and reconcilable. The modifications therefore create a well‑structured, realistic conflict across all evaluation dimensions. \n\nScore: 5",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 438,
+ "end": 483,
+ "text": "Type: CuffedTracheostomy tube type is cuffed.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 20\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "timestamp_1": "2114-08-07 04:37:00",
+ "timestamp_2": "2114-08-05 06:01:00",
+ "created_at": "2025-09-18T10:43:16.613370"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents present a clear, specific conflict on the “Day of mechanical ventilation” (20 vs 16). The change is a simple numeric alteration, which is medically plausible because separate notes may be recorded on different days or contain documentation errors. All evaluation dimensions align: temporal compatibility is realistic (different documentation times), semantic normalization matches (same field), physiological plausibility is unaffected, clinical chain plausibility holds (ventilation duration can vary), and reconciliation is straightforward (verify the correct day). The conflict is well‑crafted, realistic, and suitably detailed.\n\nScore: 5",
+ "conflict_type": "value",
+ "value": {
+ "start": 35,
+ "end": 71,
+ "text": " Day of mechanical ventilation: 20",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two documents present a clear, specific conflict on the “Day of mechanical ventilation” (20 vs 16). The change is a simple numeric alteration, which is medically plausible because separate notes may be recorded on different days or contain documentation errors. All evaluation dimensions align: temporal compatibility is realistic (different documentation times), semantic normalization matches (same field), physiological plausibility is unaffected, clinical chain plausibility holds (ventilation duration can vary), and reconciliation is straightforward (verify the correct day). The conflict is well‑crafted, realistic, and suitably detailed.\n\nScore: 5",
+ "conflict_type": "value",
+ "value": {
+ "start": 38,
+ "end": 71,
+ "text": "Day of mechanical ventilation: 16",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: PortexAllergy: albuterol (MDI) – patient reports severe bronchospasm with prior exposure.\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "timestamp_1": "2114-08-07 04:37:00",
+ "timestamp_2": "2114-08-05 06:01:00",
+ "created_at": "2025-09-18T10:43:20.133023"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two documents describe the same patient (identical weight, tube size) but introduce a direct factual clash: Document 2 adds an explicit allergy to albuterol MDI with severe bronchospasm, yet both notes state “MDI given as per order.” This creates a physiologically implausible scenario (administering a known allergen) and breaks clinical chain plausibility (standard practice would withhold the drug). Temporal compatibility is maintained (both entries refer to the same care period). Semantic placement of the allergy line is realistic within airway documentation. The conflict is clear, medically credible, and offers a plausible reconciliation (e.g., documentation error or missed allergy alert).\n\n**Score: 5**",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 470,
+ "end": 573,
+ "text": "Manufacturer: PortexAllergy: albuterol (MDI) – patient reports severe bronchospasm with prior exposure.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color is tan (previously blood‑tinged on 2114‑08‑05), indicating a change toward clearer secretions.\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum is blood‑tinged.\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "orig_doc_1": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 18\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Standard\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Diminished\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Diminished\n Comments:\n Secretions\n Sputum color / consistency: Tan / Thick\n Sputum source/amount: Suctioned / Small\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds rhonchi improving with suct sm th tan sput. MDI given as per\n order. Pt in NARD on current vent settings; no vent changes required\n overnoc. Cont PSV@noc/ trach mask as tol during day.\n",
+ "orig_doc_2": "Demographics\n Day of intubation:\n Day of mechanical ventilation: 16\n Ideal body weight: 47.6 None\n Ideal tidal volume: 190.4 / 285.6 / 380.8 mL/kg\n Airway\n Airway Placement Data\n Known difficult intubation: No\n Procedure location:\n Reason:\n Tube Type\n ETT:\n Position: cm at teeth\n Route:\n Type:\n Size:\n Tracheostomy tube:\n Type: Cuffed\n Manufacturer: Portex\n Size: 8.0mm\n PMV:\n Cuff Management:\n Vol/Press:\n Cuff pressure: 20 cmH2O\n Cuff volume: 7 mL /\n Airway problems:\n Comments:\n Lung sounds\n RLL Lung Sounds: Clear\n RUL Lung Sounds: Clear\n LUL Lung Sounds: Clear\n LLL Lung Sounds: Clear\n Comments:\n Secretions\n Sputum color / consistency: Blood Tinged /\n Sputum source/amount: Suctioned / Scant\n Comments:\n Ventilation Assessment\n Level of breathing assistance:\n Visual assessment of breathing pattern:\n Assessment of breathing comfort:\n Non-invasive ventilation assessment:\n Invasive ventilation assessment:\n Trigger work assessment:\n Dysynchrony assessment:\n Comments:\n Plan\n Next 24-48 hours:\n Reason for continuing current ventilatory support:\n Respiratory Care Shift Procedures\n Transports:\n Destination (R/T)\n Time\n Complications\n Comments\n Bedside Procedures:\n Comments: Pt cont trached and on mech vent as per Metavision. Lung\n sounds coarse suct for mod th tan sput. MDI given as per order. Pt in\n NARD on current settings; no vent changes required overnoc. Cont mech\n vent support.\n",
+ "timestamp_1": "2114-08-07 04:37:00",
+ "timestamp_2": "2114-08-05 06:01:00",
+ "created_at": "2025-09-18T10:43:23.838249"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two notes describe sputum appearance on different ventilation days (doc 2 = day 16, doc 1 = day 18). Document 1 explicitly notes a shift from blood‑tinged (on 2114‑08‑05) to tan, while Document 2 reports blood‑tinged sputum with no temporal qualifier. This creates a realistic temporal conflict: the earlier note can plausibly describe a prior state, and the later note a subsequent improvement. Semantic terms (“tan” vs “blood‑tinged”) are normalized to color descriptors, and the physiological change is plausible in recovering pneumonia or airway trauma. The clinical chain (airway irritation → blood‑tinged sputum → clearing to tan) is coherent, and a reasonable reconciliation is that the patient’s sputum cleared between day 16 and day 18. The conflict is therefore acceptable and clinically realistic.\n\nScore: 5",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 939,
+ "end": 1046,
+ "text": "Sputum color is tan (previously blood‑tinged on 2114‑08‑05), indicating a change toward clearer secretions.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two notes describe sputum appearance on different ventilation days (doc 2 = day 16, doc 1 = day 18). Document 1 explicitly notes a shift from blood‑tinged (on 2114‑08‑05) to tan, while Document 2 reports blood‑tinged sputum with no temporal qualifier. This creates a realistic temporal conflict: the earlier note can plausibly describe a prior state, and the later note a subsequent improvement. Semantic terms (“tan” vs “blood‑tinged”) are normalized to color descriptors, and the physiological change is plausible in recovering pneumonia or airway trauma. The clinical chain (airway irritation → blood‑tinged sputum → clearing to tan) is coherent, and a reasonable reconciliation is that the patient’s sputum cleared between day 16 and day 18. The conflict is therefore acceptable and clinically realistic.\n\nScore: 5",
+ "conflict_type": "comparison",
+ "value": {
+ "start": 927,
+ "end": 950,
+ "text": "Sputum is blood‑tinged.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2130-3-22**] 3:10 AM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 87880**]\n Reason: Evaluate for pneumomediastinum\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with food impaction in esophagus, taken to OR for rigid\n endoscopy/removal.\n REASON FOR THIS EXAMINATION:\n Evaluate for pneumomediastinum\n ______________________________________________________________________________\n FINAL REPORT\n CHEST PORTABLE AP.\n\n REASON FOR EXAM: Evaluate for pneumomediastinum.\n\n FINDINGS:\n\n No pneumothorax or pneumomediastinum. A focal new opacity in the right lung\n base could be due to recent aspiration or developing pneumonia. The remaining\n lungs are clear, heart size and mediastinal contours are normal.\n\n IMPRESSION:\n\n Subtle opacity in the right lower lung could be due to recent infection or\n aspiration. A early follow up CXR is recommended.\n\n",
+ "doc_2": "[**2130-3-21**] 11:02 PM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 89109**]\n Reason: evaluate for esophageal dilation or perforation\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with dysphagia, bolus sensation\n REASON FOR THIS EXAMINATION:\n evaluate for esophageal dilation or perforation\n ______________________________________________________________________________\n FINAL REPORT\n INDICATION: 62-year-old male with dysphagia.\n\n Correlation to subsequent radiograph on [**2130-3-22**].\n\n CHEST, AP: The lungs show a focal opacity in the right lung base. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.\n\n IMPRESSION: There is a focal right‑lung opacity. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.\n\n",
+ "orig_doc_1": "[**2130-3-22**] 3:10 AM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 87880**]\n Reason: Evaluate for pneumomediastinum\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with food impaction in esophagus, taken to OR for rigid\n endoscopy/removal.\n REASON FOR THIS EXAMINATION:\n Evaluate for pneumomediastinum\n ______________________________________________________________________________\n FINAL REPORT\n CHEST PORTABLE AP.\n\n REASON FOR EXAM: Evaluate for pneumomediastinum.\n\n FINDINGS:\n\n No pneumothorax or pneumomediastinum. A focal new opacity in the right lung\n base could be due to recent aspiration or developing pneumonia. The remaining\n lungs are clear, heart size and mediastinal contours are normal.\n\n IMPRESSION:\n\n Subtle opacity in the right lower lung could be due to recent infection or\n aspiration. A early follow up CXR is recommended.\n\n",
+ "orig_doc_2": "[**2130-3-21**] 11:02 PM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 89109**]\n Reason: evaluate for esophageal dilation or perforation\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with dysphagia, bolus sensation\n REASON FOR THIS EXAMINATION:\n evaluate for esophageal dilation or perforation\n ______________________________________________________________________________\n FINAL REPORT\n INDICATION: 62-year-old male with dysphagia.\n\n Correlation to subsequent radiograph on [**2130-3-22**].\n\n CHEST, AP: The lungs are clear. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.\n\n IMPRESSION: No acute intrathoracic process. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.\n\n",
+ "timestamp_1": "2130-03-22 03:10:00",
+ "timestamp_2": "2130-03-21 23:02:00",
+ "created_at": "2025-09-18T10:43:58.525185"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two reports are dated one day apart, so temporal compatibility is plausible for a new right‑base opacity to appear on the second‑day film. The first report states “no pneumothorax or pneumomediastinum” and mentions a “subtle opacity … could be due to recent aspiration or developing pneumonia.” The second report replaces the “lungs are clear” statement with the same focal opacity description, creating a direct conflict about whether the opacity was already present. This conflict is physiologically plausible (rapid evolution of aspiration‑related infiltrate) and fits a realistic clinical chain (food impaction → aspiration → early pneumonia). However, conflict 1 is essentially a null edit (no actual textual change), reducing overall conflict richness. The modifications therefore produce a mostly realistic but uneven conflict.\n\n**Score: 4**",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 707,
+ "end": 744,
+ "text": "No pneumothorax or pneumomediastinum.",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "**Reasoning (under 100 words)** \nThe two reports are dated one day apart, so temporal compatibility is plausible for a new right‑base opacity to appear on the second‑day film. The first report states “no pneumothorax or pneumomediastinum” and mentions a “subtle opacity … could be due to recent aspiration or developing pneumonia.” The second report replaces the “lungs are clear” statement with the same focal opacity description, creating a direct conflict about whether the opacity was already present. This conflict is physiologically plausible (rapid evolution of aspiration‑related infiltrate) and fits a realistic clinical chain (food impaction → aspiration → early pneumonia). However, conflict 1 is essentially a null edit (no actual textual change), reducing overall conflict richness. The modifications therefore produce a mostly realistic but uneven conflict.\n\n**Score: 4**",
+ "conflict_type": "opposition",
+ "value": {
+ "start": 731,
+ "end": 1028,
+ "text": "The lungs show a focal opacity in the right lung base. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.\n\n IMPRESSION: There is a focal right‑lung opacity. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2130-3-22**] 3:10 AM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 87880**]\n Reason: Evaluate for pneumomediastinum\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with food impaction in esophagus, taken to OR for rigid\n endoscopy/removal.\n REASON FOR THIS EXAMINATION:\n Evaluate for pneumomediastinum\n ______________________________________________________________________________\n FINAL REPORT\n CHEST PORTABLE AP.\n\n REASON FOR EXAM: Evaluate for pneumomediastinum.\n\n FINDINGS:\n\n No pneumothorax or pneumomediastinum. A focal new opacity in the right lung\n base could be due to recent aspiration or developing pneumonia. The remaining\n lungs are clear, heart size and mediastinal contours are normal.\n\n IMPRESSION:\n\n Subtle opacity in the right lower lung could be due to recent infection or\n aspiration. A early follow up CXR is recommended.\n\n",
+ "doc_2": "[**2130-3-21**] 11:02 PM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 89109**]\n Reason: evaluate for esophageal dilation or perforation\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with dysphagia, bolus sensation\n REASON FOR THIS EXAMINATION:\n evaluate for esophageal dilation or perforation\n ______________________________________________________________________________\n FINAL REPORT\n INDICATION: 62-year-old male with dysphagia.\n\n Correlation to subsequent radiograph on [**2130-3-22**].\n\n CHEST, AP: The lungs are clear. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.The right lung is not visualized on this study.\n\n IMPRESSION: No acute intrathoracic process. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.\n\n",
+ "orig_doc_1": "[**2130-3-22**] 3:10 AM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 87880**]\n Reason: Evaluate for pneumomediastinum\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with food impaction in esophagus, taken to OR for rigid\n endoscopy/removal.\n REASON FOR THIS EXAMINATION:\n Evaluate for pneumomediastinum\n ______________________________________________________________________________\n FINAL REPORT\n CHEST PORTABLE AP.\n\n REASON FOR EXAM: Evaluate for pneumomediastinum.\n\n FINDINGS:\n\n No pneumothorax or pneumomediastinum. A focal new opacity in the right lung\n base could be due to recent aspiration or developing pneumonia. The remaining\n lungs are clear, heart size and mediastinal contours are normal.\n\n IMPRESSION:\n\n Subtle opacity in the right lower lung could be due to recent infection or\n aspiration. A early follow up CXR is recommended.\n\n",
+ "orig_doc_2": "[**2130-3-21**] 11:02 PM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 89109**]\n Reason: evaluate for esophageal dilation or perforation\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with dysphagia, bolus sensation\n REASON FOR THIS EXAMINATION:\n evaluate for esophageal dilation or perforation\n ______________________________________________________________________________\n FINAL REPORT\n INDICATION: 62-year-old male with dysphagia.\n\n Correlation to subsequent radiograph on [**2130-3-22**].\n\n CHEST, AP: The lungs are clear. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.\n\n IMPRESSION: No acute intrathoracic process. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.\n\n",
+ "timestamp_1": "2130-03-22 03:10:00",
+ "timestamp_2": "2130-03-21 23:02:00",
+ "created_at": "2025-09-18T10:44:02.613222"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two reports are dated consecutively (‑21 and ‑22 March), so a temporal progression is realistic. Both use the same radiology terminology, but the second report inserts “The right lung is not visualized on this study,” directly contradicting the first report’s description of a focal opacity in the right lower lung. This creates a clear semantic clash while still being physiologically plausible—technical factors can obscure a lung on one exam and reveal pathology on a later one. The clinical narrative (food impaction → concern for perforation → assessment for pneumomediastinum) follows a logical chain, and the conflict can be reconciled by attributing the discrepancy to differing image quality. The conflict is therefore acceptable, realistic, and well‑constructed, though the description of conflict 1 is vague.\n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 695,
+ "end": 704,
+ "text": "FINDINGS:",
+ "labels": ["Conflict"]
+ }
+ },
+ {
+ "from_name": "labels_doc2",
+ "to_name": "doc_2",
+ "type": "labels",
+ "moderator_score": 4,
+ "moderator_reasoning": "The two reports are dated consecutively (‑21 and ‑22 March), so a temporal progression is realistic. Both use the same radiology terminology, but the second report inserts “The right lung is not visualized on this study,” directly contradicting the first report’s description of a focal opacity in the right lower lung. This creates a clear semantic clash while still being physiologically plausible—technical factors can obscure a lung on one exam and reveal pathology on a later one. The clinical narrative (food impaction → concern for perforation → assessment for pneumomediastinum) follows a logical chain, and the conflict can be reconciled by attributing the discrepancy to differing image quality. The conflict is therefore acceptable, realistic, and well‑constructed, though the description of conflict 1 is vague.\n\nScore: 4",
+ "conflict_type": "anatomical",
+ "value": {
+ "start": 808,
+ "end": 886,
+ "text": "There are no pleural effusions.The right lung is not visualized on this study.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ },
+ {
+ "data": {
+ "doc_1": "[**2130-3-22**] 3:10 AM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 87880**]\n Reason: Evaluate for pneumomediastinum\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with food impaction in esophagus, taken to OR for rigid\n endoscopy/removal.\n REASON FOR THIS EXAMINATION:\n Evaluate for pneumomediastinum\n ______________________________________________________________________________\n FINAL REPORT\n CHEST PORTABLE AP.\n\n REASON FOR EXAM: Evaluate for pneumomediastinum.\n\n FINDINGS:The patient has a documented allergy to barium sulfate.\n\n No pneumothorax or pneumomediastinum. A focal new opacity in the right lung\n base could be due to recent aspiration or developing pneumonia. The remaining\n lungs are clear, heart size and mediastinal contours are normal.\n\n IMPRESSION:\n\n Subtle opacity in the right lower lung could be due to recent infection or\n aspiration. A early follow up CXR is recommended.\n\n",
+ "doc_2": "[**2130-3-21**] 11:02 PM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 89109**]\n Reason: evaluate for esophageal dilation or perforation\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with dysphagia, bolus sensation\n REASON FOR THIS EXAMINATION:\n evaluate for esophageal dilation or perforation\n ______________________________________________________________________________\n FINAL REPORT\n INDICATION: 62-year-old male with dysphagia.\n\n Correlation to subsequent radiograph on [**2130-3-22**].\n\n CHEST, AP: The lungs are clear. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.\n\n IMPRESSION: No acute intrathoracic process. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.\n\n",
+ "orig_doc_1": "[**2130-3-22**] 3:10 AM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 87880**]\n Reason: Evaluate for pneumomediastinum\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with food impaction in esophagus, taken to OR for rigid\n endoscopy/removal.\n REASON FOR THIS EXAMINATION:\n Evaluate for pneumomediastinum\n ______________________________________________________________________________\n FINAL REPORT\n CHEST PORTABLE AP.\n\n REASON FOR EXAM: Evaluate for pneumomediastinum.\n\n FINDINGS:\n\n No pneumothorax or pneumomediastinum. A focal new opacity in the right lung\n base could be due to recent aspiration or developing pneumonia. The remaining\n lungs are clear, heart size and mediastinal contours are normal.\n\n IMPRESSION:\n\n Subtle opacity in the right lower lung could be due to recent infection or\n aspiration. A early follow up CXR is recommended.\n\n",
+ "orig_doc_2": "[**2130-3-21**] 11:02 PM\n CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 89109**]\n Reason: evaluate for esophageal dilation or perforation\n Admitting Diagnosis: ESOPHAGEAL FOOD IMPACTION\n ______________________________________________________________________________\n [**Hospital 2**] MEDICAL CONDITION:\n 60 year old man with dysphagia, bolus sensation\n REASON FOR THIS EXAMINATION:\n evaluate for esophageal dilation or perforation\n ______________________________________________________________________________\n FINAL REPORT\n INDICATION: 62-year-old male with dysphagia.\n\n Correlation to subsequent radiograph on [**2130-3-22**].\n\n CHEST, AP: The lungs are clear. The cardiomediastinal and hilar contours are\n normal. There are no pleural effusions.\n\n IMPRESSION: No acute intrathoracic process. Please note that barium\n esophagraphy is more appropriate for evaluation of esophageal abnormalities.\n\n",
+ "timestamp_1": "2130-03-22 03:10:00",
+ "timestamp_2": "2130-03-21 23:02:00",
+ "created_at": "2025-09-18T10:44:27.774395"
+ },
+ "annotations": [
+ {
+ "result": [
+ {
+ "from_name": "labels_doc1",
+ "to_name": "doc_1",
+ "type": "labels",
+ "moderator_score": 5,
+ "moderator_reasoning": "The two reports describe the same 60‑year‑old patient with esophageal food impaction on consecutive days. Document 1 notes a documented allergy to barium sulfate, while Document 2 recommends a barium esophagography, creating a clear semantic and physiological clash. Temporal compatibility is maintained (dates 2130‑3‑21 and 2130‑3‑22). The conflict is medically plausible because an allergy would contraindicate barium use, making the recommendation unrealistic without an alternative (e.g., water‑soluble contrast). The clinical chain (diagnosis → imaging choice) is logically inconsistent, yet the contradiction is realistic and could be reconciled by adjusting the imaging modality. \n\nScore: 5",
+ "conflict_type": "contraindication",
+ "value": {
+ "start": 695,
+ "end": 759,
+ "text": "FINDINGS:The patient has a documented allergy to barium sulfate.",
+ "labels": ["Conflict"]
+ }
+ }
+ ]
+ }
+ ]
+ }
+]
diff --git a/lib/conflicts/prompts/doctor_agent_system.txt b/lib/conflicts/prompts/doctor_agent_system.txt
index 3a02ad4..b98c129 100644
--- a/lib/conflicts/prompts/doctor_agent_system.txt
+++ b/lib/conflicts/prompts/doctor_agent_system.txt
@@ -1,4 +1,4 @@
-You are a clinical expert analyzing two medical documents and their decomposed propositions to determine what type of conflict should be introduced between them.
+You are a clinical expert analyzing two medical documents and their decomposed propositions to determine proposition pairs for each conflict type.
Available conflict types:
{conflict_types}
@@ -21,29 +21,113 @@ Propositions from Document 1:
Propositions from Document 2:
{propositions2}
-Analyze these documents and their propositions to choose the most appropriate conflict type and create specific counterfactual modifications. Consider:
+Analyze these documents and their propositions to choose the most appropriate proposition pair for each of the 6 conflict types. For each conflict type, select one proposition from Document 1 and one proposition from Document 2 that would create the most realistic and educational conflict when modified. Consider:
1. The clinical content and findings in both documents
2. The temporal relationship between the documents (timing, sequence, time gaps)
-3. Which propositions are most suitable for creating realistic conflicts
+3. Which propositions are most suitable for creating realistic conflicts for each type
4. What type of conflict would be realistic and educational given the temporal context
-5. Which conflict type best matches the available clinical information and temporal recommendations
+5. Ensure each conflict type gets a unique, well-suited proposition pair
-Create specific counterfactual modifications that will create conflicts between the documents, then provide clear step-by-step instructions for the Editor Agent.
+Create specific counterfactual modifications that will create conflicts between the documents for each conflict type, then provide clear step-by-step instructions for the Editor Agent.
Respond with JSON format:
{{
- "conflict_type": "chosen_conflict_type_key",
- "reasoning": "explanation of why this conflict type was chosen, including temporal considerations",
- "modification_instructions": "specific instructions for the Editor Agent on how to create the conflict",
- "editor_instructions": [
- "1. [Specific step for document 1]",
- "2. [Specific step for document 2]",
- "3. [Additional modification steps as needed]"
- ],
- "proposition_conflicts": [
+ "conflict_pairs": [
{{
- "doc1_proposition": "specific proposition from doc1",
- "doc2_proposition": "specific proposition from doc2"
+ "conflict_type": "opposition",
+ "reasoning": "explanation of why this proposition pair was chosen for opposition conflicts",
+ "modification_instructions": "specific instructions for the Editor Agent on how to create the opposition conflict",
+ "editor_instructions": [
+ "1. [Specific step for document 1]",
+ "2. [Specific step for document 2]",
+ "3. [Additional modification steps as needed]"
+ ],
+ "proposition_conflicts": [
+ {{
+ "doc1_proposition": "specific proposition from doc1",
+ "doc2_proposition": "specific proposition from doc2"
+ }}
+ ]
+ }},
+ {{
+ "conflict_type": "anatomical",
+ "reasoning": "explanation of why this proposition pair was chosen for anatomical conflicts",
+ "modification_instructions": "specific instructions for the Editor Agent on how to create the anatomical conflict",
+ "editor_instructions": [
+ "1. [Specific step for document 1]",
+ "2. [Specific step for document 2]",
+ "3. [Additional modification steps as needed]"
+ ],
+ "proposition_conflicts": [
+ {{
+ "doc1_proposition": "specific proposition from doc1",
+ "doc2_proposition": "specific proposition from doc2"
+ }}
+ ]
+ }},
+ {{
+ "conflict_type": "value",
+ "reasoning": "explanation of why this proposition pair was chosen for value conflicts",
+ "modification_instructions": "specific instructions for the Editor Agent on how to create the value conflict",
+ "editor_instructions": [
+ "1. [Specific step for document 1]",
+ "2. [Specific step for document 2]",
+ "3. [Additional modification steps as needed]"
+ ],
+ "proposition_conflicts": [
+ {{
+ "doc1_proposition": "specific proposition from doc1",
+ "doc2_proposition": "specific proposition from doc2"
+ }}
+ ]
+ }},
+ {{
+ "conflict_type": "contraindication",
+ "reasoning": "explanation of why this proposition pair was chosen for contraindication conflicts",
+ "modification_instructions": "specific instructions for the Editor Agent on how to create the contraindication conflict",
+ "editor_instructions": [
+ "1. [Specific step for document 1]",
+ "2. [Specific step for document 2]",
+ "3. [Additional modification steps as needed]"
+ ],
+ "proposition_conflicts": [
+ {{
+ "doc1_proposition": "specific proposition from doc1",
+ "doc2_proposition": "specific proposition from doc2"
+ }}
+ ]
+ }},
+ {{
+ "conflict_type": "comparison",
+ "reasoning": "explanation of why this proposition pair was chosen for comparison conflicts",
+ "modification_instructions": "specific instructions for the Editor Agent on how to create the comparison conflict",
+ "editor_instructions": [
+ "1. [Specific step for document 1]",
+ "2. [Specific step for document 2]",
+ "3. [Additional modification steps as needed]"
+ ],
+ "proposition_conflicts": [
+ {{
+ "doc1_proposition": "specific proposition from doc1",
+ "doc2_proposition": "specific proposition from doc2"
+ }}
+ ]
+ }},
+ {{
+ "conflict_type": "descriptive",
+ "reasoning": "explanation of why this proposition pair was chosen for descriptive conflicts",
+ "modification_instructions": "specific instructions for the Editor Agent on how to create the descriptive conflict",
+ "editor_instructions": [
+ "1. [Specific step for document 1]",
+ "2. [Specific step for document 2]",
+ "3. [Additional modification steps as needed]"
+ ],
+ "proposition_conflicts": [
+ {{
+ "doc1_proposition": "specific proposition from doc1",
+ "doc2_proposition": "specific proposition from doc2"
+ }}
+ ]
}}
]
}}