Refine graphical CCS interview flow
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@@ -56,60 +56,17 @@
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{
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"id": "fatigue_course",
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"clinicianText": "How has the fatigue affected you, and how have you been sleeping and eating?",
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"patientText": "My energy is down by the afternoon. I have been eating less because my stomach bothers me, and the discomfort sometimes wakes me at night, so I am not sleeping well.",
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"patientText": "My energy is down by the afternoon, even on days when I sleep normally. I have not noticed fever, shortness of breath, chest pain, or a major change in my appetite.",
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"required": true,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "abdominal_symptoms",
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"clinicianText": "You mentioned your stomach. Please describe the discomfort and when it occurs.",
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"patientText": "It is a dull, gnawing ache high in the middle of my abdomen. It is usually worse late at night or when I have not eaten. A snack or an antacid settles it for a while, but then it comes back.",
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"required": true,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "bleeding_alarm_features",
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"clinicianText": "Have you had black stools, blood in vomit or stool, trouble swallowing, persistent vomiting, weight loss, or severe sudden pain?",
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"patientText": "No. My stools look normal, I have not vomited blood, swallowing is fine, and my weight has been steady. I have not had severe or sudden pain.",
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"required": true,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "medications",
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"clinicianText": "What medicines do you take, including aspirin, ibuprofen, naproxen, or other over-the-counter products?",
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"patientText": "I do not take any prescriptions. I use acetaminophen once in a while for a headache, but I do not use aspirin, ibuprofen, or naproxen.",
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"required": false,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "medical_history",
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"clinicianText": "Do you have prior stomach problems, other medical conditions, surgeries, or medication allergies?",
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"patientText": "I have never been diagnosed with an ulcer and have not had surgery. I am generally healthy and have no known medication allergies.",
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"required": false,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "social_history",
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"clinicianText": "Do you smoke, drink alcohol, or use recreational drugs?",
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"patientText": "I do not smoke or use drugs. I might have one or two beers on a weekend, but not every week.",
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"required": false,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "additional_review",
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"clinicianText": "Any fever, shortness of breath, headaches, bowel changes, or urinary symptoms?",
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"patientText": "No fever, shortness of breath, unusual headaches, bowel changes, or urinary trouble.",
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"required": false,
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"prerequisiteTopicIds": ["chief_concern"]
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}
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],
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"debrief": {
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"likelyDiagnosis": "Probable uncomplicated H. pylori–associated duodenal ulcer",
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"summary": "The key pattern is gnawing epigastric discomfort when fasting or at night with temporary relief from food or antacids. The interview found no evidence of active gastrointestinal bleeding or other alarm features. H. pylori infection is a leading cause, but it would require confirmatory testing.",
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"likelyDiagnosis": "Lightheadedness and fatigue requiring further evaluation",
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"summary": "The focused opening interview identifies intermittent orthostatic lightheadedness without vertigo or syncope and several weeks of nonspecific fatigue. Additional clinical assessment would be needed before assigning a diagnosis.",
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"teachingPoints": [
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"Clarify whether dizziness is vertigo, presyncope, or disequilibrium and screen for neurologic and cardiac warning symptoms.",
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"Ask directly about melena, hematemesis, syncope, weight loss, dysphagia, persistent vomiting, and sudden severe pain.",
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"Review NSAID and aspirin exposure even when the history suggests H. pylori infection."
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"Characterize the timing and functional impact of fatigue and ask about sleep, intake, and associated systemic symptoms."
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]
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}
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},
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@@ -120,13 +77,7 @@
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"scoringCriteria": [
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{ "id": "elicit_chief_concern", "title": "Elicit the chief concern", "actionType": "dialogue_choice", "targetCode": "chief_concern", "points": 10, "rationale": "An open-ended opening allows the patient to identify lightheadedness and fatigue in his own words." },
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{ "id": "characterize_dizziness", "title": "Characterize the dizziness", "actionType": "dialogue_choice", "targetCode": "dizziness_character", "points": 15, "rationale": "Distinguishing presyncope from vertigo and screening for neurologic and cardiac warning symptoms focuses the differential." },
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{ "id": "explore_fatigue", "title": "Explore fatigue, sleep, and intake", "actionType": "dialogue_choice", "targetCode": "fatigue_course", "points": 10, "rationale": "Poor intake and sleep disruption provide a coherent context for the nonspecific fatigue." },
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{ "id": "characterize_abdominal_pain", "title": "Characterize abdominal symptoms", "actionType": "dialogue_choice", "targetCode": "abdominal_symptoms", "points": 20, "rationale": "Timing, location, quality, and relieving factors establish the ulcer-like dyspepsia pattern." },
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{ "id": "screen_alarm_features", "title": "Screen for bleeding and alarm features", "actionType": "dialogue_choice", "targetCode": "bleeding_alarm_features", "points": 20, "rationale": "Bleeding and other alarm features would change the urgency and evaluation." },
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{ "id": "review_medications", "title": "Review NSAID and aspirin exposure", "actionType": "dialogue_choice", "targetCode": "medications", "points": 10, "rationale": "Medication exposure is a major alternative cause of peptic ulcer disease." },
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{ "id": "review_background", "title": "Review medical history and allergies", "actionType": "dialogue_choice", "targetCode": "medical_history", "points": 5, "rationale": "Background history informs risk and future treatment selection." },
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{ "id": "review_social_history", "title": "Review social history", "actionType": "dialogue_choice", "targetCode": "social_history", "points": 5, "rationale": "Tobacco and heavy alcohol exposure can affect symptoms and risk." },
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{ "id": "complete_review", "title": "Complete a focused review of systems", "actionType": "dialogue_choice", "targetCode": "additional_review", "points": 5, "rationale": "A focused review checks for competing causes and associated illness." }
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{ "id": "explore_fatigue", "title": "Explore fatigue, sleep, and intake", "actionType": "dialogue_choice", "targetCode": "fatigue_course", "points": 10, "rationale": "The course and associated symptoms help characterize the nonspecific fatigue." }
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],
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"references": [
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{
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