"""
camcops_server/tasks/ciwa.py
===============================================================================
Copyright (C) 2012, University of Cambridge, Department of Psychiatry.
Created by Rudolf Cardinal (rnc1001@cam.ac.uk).
This file is part of CamCOPS.
CamCOPS is free software: you can redistribute it and/or modify
it under the terms of the GNU General Public License as published by
the Free Software Foundation, either version 3 of the License, or
(at your option) any later version.
CamCOPS is distributed in the hope that it will be useful,
but WITHOUT ANY WARRANTY; without even the implied warranty of
MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
GNU General Public License for more details.
You should have received a copy of the GNU General Public License
along with CamCOPS. If not, see <https://www.gnu.org/licenses/>.
===============================================================================
"""
from typing import Any, Dict, List, Tuple, Type
from cardinal_pythonlib.stringfunc import strseq
from sqlalchemy.ext.declarative import DeclarativeMeta
from sqlalchemy.sql.schema import Column
from sqlalchemy.sql.sqltypes import Float, Integer
from camcops_server.cc_modules.cc_constants import CssClass
from camcops_server.cc_modules.cc_ctvinfo import CTV_INCOMPLETE, CtvInfo
from camcops_server.cc_modules.cc_db import add_multiple_columns
from camcops_server.cc_modules.cc_html import (
answer,
subheading_spanning_two_columns,
tr,
tr_qa,
)
from camcops_server.cc_modules.cc_request import CamcopsRequest
from camcops_server.cc_modules.cc_snomed import SnomedExpression, SnomedLookup
from camcops_server.cc_modules.cc_sqla_coltypes import (
CamcopsColumn,
MIN_ZERO_CHECKER,
PermittedValueChecker,
SummaryCategoryColType,
)
from camcops_server.cc_modules.cc_summaryelement import SummaryElement
from camcops_server.cc_modules.cc_task import (
get_from_dict,
Task,
TaskHasClinicianMixin,
TaskHasPatientMixin,
)
from camcops_server.cc_modules.cc_text import SS
from camcops_server.cc_modules.cc_trackerhelpers import (
TrackerLabel,
TrackerInfo,
)
# =============================================================================
# CIWA
# =============================================================================
class CiwaMetaclass(DeclarativeMeta):
# noinspection PyInitNewSignature
def __init__(
cls: Type["Ciwa"],
name: str,
bases: Tuple[Type, ...],
classdict: Dict[str, Any],
) -> None:
add_multiple_columns(
cls,
"q",
1,
cls.NSCOREDQUESTIONS - 1,
minimum=0,
maximum=7,
comment_fmt="Q{n}, {s} (0-7, higher worse)",
comment_strings=[
"nausea/vomiting",
"tremor",
"paroxysmal sweats",
"anxiety",
"agitation",
"tactile disturbances",
"auditory disturbances",
"visual disturbances",
"headache/fullness in head",
],
)
super().__init__(name, bases, classdict)
[docs]class Ciwa(
TaskHasPatientMixin, TaskHasClinicianMixin, Task, metaclass=CiwaMetaclass
):
"""
Server implementation of the CIWA-Ar task.
"""
__tablename__ = "ciwa"
shortname = "CIWA-Ar"
provides_trackers = True
NSCOREDQUESTIONS = 10
SCORED_QUESTIONS = strseq("q", 1, NSCOREDQUESTIONS)
q10 = CamcopsColumn(
"q10",
Integer,
permitted_value_checker=PermittedValueChecker(minimum=0, maximum=4),
comment="Q10, orientation/clouding of sensorium (0-4, higher worse)",
)
t = Column("t", Float, comment="Temperature (degrees C)")
hr = CamcopsColumn(
"hr",
Integer,
permitted_value_checker=MIN_ZERO_CHECKER,
comment="Heart rate (beats/minute)",
)
sbp = CamcopsColumn(
"sbp",
Integer,
permitted_value_checker=MIN_ZERO_CHECKER,
comment="Systolic blood pressure (mmHg)",
)
dbp = CamcopsColumn(
"dbp",
Integer,
permitted_value_checker=MIN_ZERO_CHECKER,
comment="Diastolic blood pressure (mmHg)",
)
rr = CamcopsColumn(
"rr",
Integer,
permitted_value_checker=MIN_ZERO_CHECKER,
comment="Respiratory rate (breaths/minute)",
)
MAX_SCORE = 67
[docs] @staticmethod
def longname(req: "CamcopsRequest") -> str:
_ = req.gettext
return _(
"Clinical Institute Withdrawal Assessment for Alcohol "
"Scale, Revised"
)
[docs] def get_trackers(self, req: CamcopsRequest) -> List[TrackerInfo]:
return [
TrackerInfo(
value=self.total_score(),
plot_label="CIWA total score",
axis_label=f"Total score (out of {self.MAX_SCORE})",
axis_min=-0.5,
axis_max=self.MAX_SCORE + 0.5,
horizontal_lines=[14.5, 7.5],
horizontal_labels=[
TrackerLabel(17, req.sstring(SS.SEVERE)),
TrackerLabel(11, req.sstring(SS.MODERATE)),
TrackerLabel(3.75, req.sstring(SS.MILD)),
],
)
]
[docs] def get_clinical_text(self, req: CamcopsRequest) -> List[CtvInfo]:
if not self.is_complete():
return CTV_INCOMPLETE
return [
CtvInfo(
content=f"CIWA total score: "
f"{self.total_score()}/{self.MAX_SCORE}"
)
]
[docs] def get_summaries(self, req: CamcopsRequest) -> List[SummaryElement]:
return self.standard_task_summary_fields() + [
SummaryElement(
name="total",
coltype=Integer(),
value=self.total_score(),
comment=f"Total score (/{self.MAX_SCORE})",
),
SummaryElement(
name="severity",
coltype=SummaryCategoryColType,
value=self.severity(req),
comment="Likely severity",
),
]
[docs] def is_complete(self) -> bool:
return (
self.all_fields_not_none(self.SCORED_QUESTIONS)
and self.field_contents_valid()
)
def total_score(self) -> int:
return self.sum_fields(self.SCORED_QUESTIONS)
def severity(self, req: CamcopsRequest) -> str:
score = self.total_score()
if score >= 15:
severity = self.wxstring(req, "category_severe")
elif score >= 8:
severity = self.wxstring(req, "category_moderate")
else:
severity = self.wxstring(req, "category_mild")
return severity
[docs] def get_task_html(self, req: CamcopsRequest) -> str:
score = self.total_score()
severity = self.severity(req)
answer_dicts_dict = {}
for q in self.SCORED_QUESTIONS:
d = {None: None}
for option in range(0, 8):
if option > 4 and q == "q10":
continue
d[option] = self.wxstring(req, q + "_option" + str(option))
answer_dicts_dict[q] = d
q_a = ""
for q in range(1, Ciwa.NSCOREDQUESTIONS + 1):
q_a += tr_qa(
self.wxstring(req, "q" + str(q) + "_s"),
get_from_dict(
answer_dicts_dict["q" + str(q)],
getattr(self, "q" + str(q)),
),
)
tr_total_score = tr(
req.sstring(SS.TOTAL_SCORE), answer(score) + f" / {self.MAX_SCORE}"
)
tr_severity = tr_qa(
self.wxstring(req, "severity") + " <sup>[1]</sup>", severity
)
return f"""
<div class="{CssClass.SUMMARY}">
<table class="{CssClass.SUMMARY}">
{self.get_is_complete_tr(req)}
{tr_total_score}
{tr_severity}
</table>
</div>
<table class="{CssClass.TASKDETAIL}">
<tr>
<th width="35%">Question</th>
<th width="65%">Answer</th>
</tr>
{q_a}
{subheading_spanning_two_columns(
self.wxstring(req, "vitals_title"))}
{tr_qa(self.wxstring(req, "t"), self.t)}
{tr_qa(self.wxstring(req, "hr"), self.hr)}
{tr(self.wxstring(req, "bp"),
answer(self.sbp) + " / " + answer(self.dbp))}
{tr_qa(self.wxstring(req, "rr"), self.rr)}
</table>
<div class="{CssClass.FOOTNOTES}">
[1] Total score ≥15 severe, ≥8 moderate, otherwise
mild/minimal.
</div>
"""
[docs] def get_snomed_codes(self, req: CamcopsRequest) -> List[SnomedExpression]:
codes = [
SnomedExpression(
req.snomed(SnomedLookup.CIWA_AR_PROCEDURE_ASSESSMENT)
)
]
if self.is_complete():
codes.append(
SnomedExpression(
req.snomed(SnomedLookup.CIWA_AR_SCALE),
{
req.snomed(
SnomedLookup.CIWA_AR_SCORE
): self.total_score()
},
)
)
return codes