La receta médica: ¿reflejo condicionado o reflexión consciente? / Medical prescription: conditioned reflex or conscious reflection?

Resumen Extender una receta o indicar un tratamiento suele ser la última parte de la consulta médica. Este proceso crucial puede desvirtuarse debido a múltiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexión o tiempo. La información insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organización Mundial de la Salud, hace énfasis en hacer del proceso prescriptivo un ejercicio de reflexión.

Abstract Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise.

Sistema de apoyo al diagnóstico médico de COVID-19 mediante mapa cognitivo difuso / Support system to Covid-19 medical diagnosis via diffuse cognitive map

Introducción: Los escenarios de convivencia de las diversas poblaciones son muy complejos, lo que contribuye con la propagación de enfermedades. Diagnosticar tempranamente enfermedades infecciosas representa una tarea fundamental para disminuir su propagación y evitar epidemias. Sin embargo, la inconsistencia en los datos de poblaciones y la imposibilidad de contar con un diagnóstico oportuno en muchos casos trae como consecuencia la proliferación de pandemias tales como la COVID-19. Objetivo: Desarrollar un sistema de apoyo al diagnóstico médico para COVID-19 a partir de la modelación de las relaciones causales de los criterios de diagnóstico, para conformar el mapa cognitivo difuso. Métodos: Para el desarrollo de la investigación se utilizaron métodos teóricos, empíricos y estadísticos, tales como: analítico-sintético, inductivo-deductivo, hipotético-deductivo, modelación. Como método empírico se utilizó la entrevista semiestructurada con la intención de recoger información que permitiera incluir contenidos no prescritos y precisar el conocimiento de los expertos sobre los principales indicadores para la toma de decisiones en el diagnóstico médico de la COVID-19. Resultados: El sistema funciona a través de un mapa cognitivo difuso para modelar las relaciones causales que representan la base de la inferencia. Se utilizan técnicas de inteligencia artificial como base al diagnóstico médico. Se presenta un ejemplo demostrativo para el diagnóstico médico de la COVID-19 en el que se modelan las relaciones causales de los diferentes conceptos que describen la enfermedad provocada. Conclusiones: El sistema diseñado constituye una herramienta viable de apoyo a la toma de decisiones en el diagnóstico médico de la COVID-19, que permite obtener criterios evaluativos a partir de la modelación de las relaciones causales, esto lo hace extensible a otros tipos de situaciones de emergencias sanitarias(AU)

Introduction: Different populations coexistence scenarios are very complex, which contributes to the spread of diseases. Diagnosing infectious diseases early is a critical task in reducing its spread and preventing epidemics. However, inconsistency in population data and the inability to have timely diagnosis in many cases result in the proliferation of pandemics such as COVID-19. Objective: Develop a support system for COVID-19 medical diagnostic from modeling causal relations of diagnostic criteria, to form the diffuse cognitive map. Methods: Theoretical, empirical and statistical methods were used for the development of the research, such as: analytical-synthetic, inductive-deductive, hypothetical-deductive, modeling. As an empirical method, the semi-structured interview was used with the intention of collecting information that would include unprescribed contents and require expert knowledge of the main indicators for decision-making in COVID-19 medical diagnosis. Results: The system works through a diffuse cognitive map to model causal relationships that represent the inference´s basis. Artificial intelligence techniques are used as a basis for medical diagnosis. A demonstrative example is presented for COVID-19 medical diagnosis in which are modelled the causal relations of the different concepts that the disease describes. Conclusions: The designed system is a viable support tool for decision-making in COVID-19 medical diagnosis, which allows to obtain evaluative criteria from the modelling of causal relations, and this makes it extendable to other types of health emergencies situations(AU)

Application of human face recognition technology in genetic syndrome diagnosis / 中华实用儿科临床杂志

Genetic syndromes often involve craniofacial malformations,and certain syndromes are associated with a specific facial pattern such as Down syndrome.With the development of artificial intelligence in the medical field,face recognition technology has been successfully applied in the diagnosis of genetic syndrome,such as Down syndrome,Cornelia de Lange syndrome,22q11.2 deletion syndrome and Noonan syndrome.Some reports suggested that the detection rates of face recognition technology are higher than clinical specialists.In the future,face recognition technology is expected to be applied in the screening of and genetic syndromes,to help the diagnosis and to be applied in scientific research.

Present status and development trend of diagnosis coding in medical record homepage / 中华医院管理杂志

This paper analyzed the development and main problems found in medical diagnosis coding of medical record homepage. It proposed that it is imperative to unify the coding criteria, to correctly identify coding techniques, and to organize the coding work scientifically. On that basis, the paper discussed the development trend and strategy of medical diagnosis coding work for medical record homepage. As an important data source, the homepage of medical records will continue to exist and play a more important role. With the release of ICD-11 and the standardization of medical terms, the diagnosis coding technology will progress very rapidly. Such factors as the technical complexity and the sizable workload of routine coding, have decided fulltime coders will continue their key role as before. Hospitals are recommended to emphasize the quality of medical record homepage, and their diagnosis coding work.

Síndrome. Empleo inadecuado del término en la Discusión Diagnóstica. Semejanzas y divergencias en el criterio de expertos / Inappropriate use of the term Syndrome in the Diagnostic Discussion. Similarities and divergences in the criterion of experts

Introducción: hay casos de uso inadecuado del término síndrome en la discusión diagnóstica, en el Hospital Universitario V.I. Lenin de Holguín, lo que puede deberse a diversos factores. Objetivo: identificar, según el criterio de expertos, si existen en otras provincias de Cuba casos de uso inadecuado del término síndrome en la discusión diagnóstica, su repercusión negativa en el diagnóstico médico, principales manifestaciones del uso inadecuado, probables causas, necesidad de consenso y de reemplazo conceptual. Métodos: estudio observacional descriptivo con triangulación metodológica. Muestra intencionada de 15 expertos de diferentes provincias, profesores auxiliar o titular, máster, doctor en ciencias o ambos y especialistas de primer o segundo grado en medicina interna, quienes contestaron, por vía electrónica, una encuesta con diversos ítems y preguntas, tipo Escala Likert. La encuesta fue validada estadísticamente, los datos fueron procesados con uso de la mediana y de cuartiles mediante: test de Anova, coeficiente de correlación de Kendall y análisis clúster. Resultados: la mayoría de expertos concordaron en que existen casos de uso inadecuado del término síndrome en las discusiones diagnósticas, su negativa repercusión en el diagnóstico médico, posibles causas, necesidad de consenso con algunas divergencias, entre tres grupos de expertos, respecto a formas de manifestarse, otros factores influyentes y en especial sobre la ampliación del concepto síndrome, mediante la inclusión de signos propios de los exámenes complementarios, y su posible consecuencia en el algoritmo del método clínico. Conclusiones: aunque la mayoría de expertos concordaron sobre la existencia de uso inadecuado del término síndrome y otros aspectos relacionados, la existencia de divergencias, en especial sobre el reemplazo conceptual del término y su repercusión en el proceso diagnóstico hace plantear la existencia de una escuela heterodoxa (minoría), una escuela ortodoxa o tradicional (mayoría) y una escuela ecléctica, intermedia en número de expertos.

Introduction: there have been cases of misuse of the term syndrome in diagnostic discussion at the University Hospital of Holguin V.I. Lenin, which may be due to several factors. Objective: to identify, according to expert criteria, if there are cases of inappropriate use of the term syndrome in the diagnostic discussion in other provinces of Cuba, its negative repercussion in the medical diagnosis, main manifestations of the inadequate use, probable causes, need of consensus and of conceptual replacement. Method: descriptive observational study with methodological triangulation. Intentional sample of 15 experts from different provinces, assistant or master professors, master, doctor of science or both and specialists of first or second degree on internal medicine, who answered, electronically, a survey with various items and questions, Likert Scale. The survey was statistically validated; the data were processed using the median and quartiles using: anova test, Kendall correlation coefficient and cluster analysis. Results: the majority of experts agreed that there are cases of inadequate use of the term syndrome in diagnostic discussions, its negative repercussion in the medical diagnosis, possible causes, need for consensus with some divergences, among three groups of experts, regarding forms of manifestation, other influential factors and especially on the extension of the syndrome concept, through the inclusion of signs of complementary examinations and their possible consequence in the algorithm of the clinical method. Conclusions: although most experts agreed on the existence of inappropriate use of the term syndrome and other related aspects, the existence of divergences, especially on the conceptual replacement of the term and its repercussion in the diagnostic process, suggests the existence of a heterodox school (minority), an orthodox or traditional school (majority) and an eclectic school, intermediate in number of experts.

Burocracia pública e política social no Brasil / Street-level Bureaucracy and Social Policy in Brazil

Resumo O artigo descreve a burocracia do governo central brasileiro e o acesso da pessoa com deficiência ao Benefício de Prestação Continuada (BPC). Este acesso é dependente da avaliação da condição de vulnerabilidade realizada pela burocracia ministerial. Foram utilizadas revisão de literatura e dados secundários de séries de tempo e transversal para descrever a burocracia federal. Documentos legais e indicadores descrevem o regime de avaliação pericial. É demonstrada a evolução desigual no quantitativo da burocracia de carreira do governo central brasileiro nas últimas duas décadas. Resultado: O governo central brasileiro adotou a concepção internacional da pessoa com deficiência na avaliação dos requerentes ao BPC. A despeito dessa decisão, é demonstrado que o governo central brasileiro ampliou seletivamente a burocracia de carreira para atuar na área social. Constou-se que o resultado do processo de avaliação foi bastante severo, favorecendo os requerentes em condição de extrema vulnerabilidade biomédica. A despeito da adoção do modelo social, a elegibilidade ao BPC é subordinada ao diagnóstico médico.

Abstract This paper describes the Brazilian central government bureaucracy and people with disabilities' access to the Continuous Cash Benefit (BPC). This access depends on the Ministry of Social Security bureaucracy's evaluation of the condition of vulnerability. We performed a literature review, analysis of secondary data from time series and cross-sectional data to describe street-level federal bureaucracy. Legal documents and indicators describe the expert evaluation regimen of the Ministry of Social Security (MPS). This paper shows the uneven growth of the number of career public servants of the central government in the last two decades. The Brazilian central government has adopted the international concept of person with disabilities in the evaluation of BPC applicants. Despite this decision, it is shown that the Brazilian central government expanded selectively the career bureaucracy to work in the social area. It was found that the result of the evaluation process was quite strict, favoring applicants in conditions of extreme biomedical vulnerability. Despite adopting the social model, BPC eligibility is tied to medical diagnosis.

Propuestas de acercamiento al diagnóstico de la afectación y el padecer en la carrera de Medicina / Approach proposals to the diagnosis of affectation and suffering in the medicine career

Introducción: A pesar del tiempo transcurrido, el paradigma biologicista de atención médica no ha sido sustituido por el paradigma biopsicosocial. En el programa de la carrera no hay definición clara de los términos para que los estudiantes de Medicina en su tercer año, durante la estancia en salas de Medicina Interna se acerquen al diagnóstico de la afectación y el padecer. Objetivo: Elaborar una propuesta argumentada de acercamiento al diagnóstico de la afectación y el padecer por estudiantes de Medicina durante su estancia en salas de Medicina Interna. Material y Métodos: Se realizó una revisión narrativa de la literatura seleccionada, obtenida mediante el motor de búsqueda Google Académico y la base de datos Scielo de la Biblioteca Virtual de Salud. Resultados: El Índice de Barthel permite suficiente acercamiento al diagnóstico de la discapacidad como concepto asociado a la afectación. La respuesta emocional del paciente puede definirse como adaptativa ­ adecuada ­ conveniente o como inadaptativa ­ inadecuada ­ inconveniente para la solución de su problema de salud. Conclusiones: Se proponen términos concretos para el acercamiento al diagnóstico de la afectación y el padecer para el estudiante de Medicina(AU)

Introduction: In spite of the elapsed time the biologistic paradigm of medical attention has not been substituted by the bio psychosocial. In the career's program, there is no obvious definition of terms in order that the third year medicine students, during their stay in the Internal Medicine wards, approach to the diagnosis of affectation and suffering. Objective: Elaborate an argued proposal of approach to the diagnosis of affectation and suffering for students of medicine during his stay in Internal Medicine wards. Material and Methods: Was performed a narrative revision of the selected literature obtained by means of the computer search engine google academic and SciELO data base of the Health's Virtual Library. Results: Barthel's index enables an enough approach to the diagnosis of the disability as a correlated concept with affectation. The patient's emotional reaction can be defined as adequate ­ adaptive -convenient or inadequate ­ inconvenient and maladaptive for the solution of his problem of health. Conclusions: The authors propose specific terms for the approach to the diagnosis of affectation and suffering for the student of medicine(AU)

Método clínico. Vulnerabilidad y perspectivas en Estomatología / Clinical method. Vulnerabilities and perspectives in Stomatology

La correcta aplicación del método clínico constituye la base de una atención de calidad a la población. En los últimos años se ha observado un deterioro universal de este, situación no ajena al contexto social cubano, por lo que se presenta como una problemática de salud actual. El objetivo de este trabajo fue considerar aspectos que pueden vulnerar el método clínico en Estomatología, su repercusión en el diagnóstico y el tratamiento, imprescindibles para obtener mejor calidad en la atención a la población. Se efectuó una revisión bibliográfica acerca del método clínico, para lo cual se consideraron como palabras claves: método clínico, diagnóstico médico, problemas de salud, en el período comprendido entre 1966 a 2015. Fueron consultadas las bases de datos: Google Scholar, Ebsco, Lilacs, Pumed y SciELO; de las cuales 41 artículos se tuvieron en cuenta y de estos 27 pertenecían a los últimos 5 años. Se concluyó que el método clínico puede ser vulnerado al realizar algunos procederes de la Estomatología, en detrimento del diagnóstico y la conducta terapéutica. Estas acciones, pueden conducir al deterioro de la relación estomatólogo-paciente, que constituye uno de los aspectos más humanos y esenciales en la profesión. El dominio del método clínico es indispensable para la solución de los problemas de salud bucal y está determinado por la dedicación de los profesionales a su labor, caracterizada por el desarrollo de su capacidad científico técnica, el cumplimiento de los principios éticos y el deber de restablecer la salud del ser humano.

The correct application of the clinical method is the base of population’s quality care. In the last years, a universal deterioration of this method has been observed. This situation is not unknown in the Cuban social context, being, therefore, a health problem nowadays. The aim of this work was considering aspects that may damage clinical method in Stomatology, its repercussion in the diagnosis and treatment, essential for achieving better quality in population’s care. A bibliography review on the clinical method was carried out in the period between 1966 and 2015, considering as key words the following: clinical method, medical diagnosis, health problems. The consulted databases were Google Scholar, Ebsco, Lilacs, Pubmed and Scielo, taking into account 41 articles, 27 of them from the last five years. We arrived to the conclusion that the clinical method might be transgressed when carrying out some procedures of the Stomatology, detracting prognosis and therapeutic behavior. These actions might lead to the deterioration of the stomatologist-patient relations, one of the most humanistic and essential aspects of the profession. Knowing well the clinical method is unavoidable for the solution of the oral health problems, and it is determined by the professionals’ dedication to their work, characterized by the development of their scientific-technical capacity, the fulfillment of the ethical principles and the duty of reestablishing human people health.

Diagnóstico médico / Medical diagnostic

El diagnóstico es objetivo central del acto médico, entendido este como relación médico-paciente. "Llamamos diagnóstico al arte de identificar una enfermedad a través de los signos y síntomas que el paciente presenta". De esta forma el artículo intenta una reflexión sobre la importancia de llegar a él a través de una praxis clínica con so-porte documental en la adecuada elaboración de una historia clínica; previa a la utilización del recurso par

The diagnosis is a central objective of the medical act, understood this, as the relationship doctor-patient. "We call the art of identifying a disease through the signs and symptoms that the patient has diagnosis". Thus the article tries to reflect on the importance of reach him through a clinical practice with documentary support in the proper preparation of a medical history prior to the use of the paraclinic resource.

An overview of pertussis reemergence and evidence of ITS resurgence in Brazil

About two thousand cases of pertussis are reported in Brazil each year, with the highest incidence and mortality rates occurring in children under one year old. The disease is becoming common in Brazil; however the state of Rio de Janeiro has been showing low reporting figures in relation to other states in the Southeast region. This research work aimed to evaluate the difficulties faced by medical teams when confirming suspect cases of pertussis in healthcare units throughout the state of Rio de Janeiro and to use available data to confirm pertussis diagnosis within the last two years. Epidemiological surveys were conducted among medical personnel from healthcare units who presented the main obstacles to confirming suspect cases. Results show that a lack of laboratory diagnosis, poor differential diagnosis, low knowledge of the disease and a lack of clinical experience are, among other factors, relevant to the low reporting rates in the region...

Cerca de dois mil casos de coqueluche são relatados no Brasil a cada ano. Crianças com menos de 1 ano de idade pertencem ao grupo com maiores taxas de incidência e letalidade. Apesar de a doença estar se tornando cada vez mais frequente no Brasil, o estado do Rio de Janeiro vem apresentando baixos índices de informação comparativamente a outros estados da Região Sudeste. Portanto, este trabalho teve como objetivo avaliar tanto as dificuldades enfrentadas pelas equipes médicas ao confirmar casos suspeitos de coqueluche em unidades de saúde em todo o estado do Rio de Janeiro quanto a disponibilidade de dados para confirmar o diagnóstico da coqueluche nos últimos dois anos. O levantamento epidemiológico foi realizado entre o pessoal médico de unidades de saúde que apresentaram dificuldades para a confirmação de casos suspeitos. Os resultados indicaram alguns fatores relevantes para as baixas taxas de notificação na região: falta de diagnóstico laboratorial, inconsistência do diagnóstico diferencial, escassez de conhecimento sobre a doença e falta de experiência clínica...

Design of fuzzy expert system for diagnosis of cardiac diseases .

Background: The logical thinking of medical practitioners play significant role in decision making about diagnosis. It exhibits variation in decisions because of their approaches to deal with uncertainties and vagueness in the knowledge and information. Fuzzy logic has proved to be the remarkable tool for building intelligent decision making systems for approximate reasoning that can appropriately handle both the uncertainty and imprecision. Aims & Objective: To develop a generic fuzzy expert system framework that can be used to design specific fuzzy expert systems for particular medical domain. Material and Methods: The generic fuzzy expert system has been designed for diagnosis of cardiac diseases. The interface between visual basic and MatLab is powerful feature of the system that offers user friendly graphical user interface. Results: Need to arrive at the most accurate medical diagnosis in a timely manner is the main outcome that may reduce the further complications. A generic fuzzy expert system for the diagnosis of various heart diseases yields better result than the classic designed systems, because this system simulates the manner of an expert in true sense. Conclusion: The particular focus is on diagnosis of heart disease by employing the fuzzy logic in expert systems. The system has been designed and tested successfully. Exhaustive rule base specifically formed for almost all heart diseases ensures the accuracy to arrive at certain decision.

Bases y aplicación del método hipotético-deductivo en el diagnóstico / Rules and implementation of the deductive-hypothetical method in diagnosis

La identificación correcta de los problemas de salud del paciente constituye la base en que descansa la actuación profesional de los médicos y la clave para una atención de calidad. El propósito de este trabajo es describir el método hipotético-deductivo y su utilización en el proceso del diagnóstico, mostrando ejemplos prácticos de casos clínicos que pueden ser similares a los vistos en la atención primaria. Se realizó un trabajo de revisión de artículos nacionales y algunos extranjeros que abordan el diagnóstico médico y la aplicación del método hipotético-deductivo en el proceso del diagnóstico. Los médicos a medida que ganan en conocimientos y experiencias simplifican el proceso del diagnóstico y con pocos datos elaboran sus hipótesis diagnósticas (método hipotético-deductivo), dirigiendo el interrogatorio, el examen físico y las exploraciones complementarias hacia la comprobación o rechazo de los diagnósticos iniciales. Si se rechaza el diagnóstico inicial hay que comenzar de nuevo el proceso. El método hipotético-deductivo es muy eficiente siempre que se aplique correctamente, por un personal experimentado y con las condiciones necesarias. Este método no está exento de errores si se violan sus principios

ABSTRACT The proper identification of health problems of patient is the basis supporting the professional performance of physicians and the key for a quality care. The purpose of present paper is to describe the deductive-hypothetical method and its use in the diagnostic process, showing practical examples of clinical cases that could be similar to that observed in the primary care. A review work was made of national and foreign papers approaching the medical diagnosis y the implementation of the above mentioned method in the process of diagnosis. The physicians according to a increase in knowledges and experiences may to simplify the process of diagnosis and with a few data they made its diagnostic hypotheses (deductive-hypothetic method), directing the questioning, the physical examination and the complementary screenings towards the verification or the rejection of initial diagnoses. If initial diagnosis is rejected it is necessary to start again the process. The deductive-hypothetical method is very effective whenever it be properly applied by a experimented staff and with the necessary conditions. The method is not extent of errors if its principles are infringed

Bases y particularidades del método clínico en la atención primaria de salud / Basis and peculiarities of clinical method of primary health care

El diagnóstico médico es la base de una atención de calidad a nuestros pacientes. Se realizó una revisión de la literatura nacional y de algunos trabajos extranjeros sobre el método clínico, su importancia, bases, procedimientos y características fundamentales en la atención primaria, enfatizando en la morbilidad en ese nivel de atención, las peculiaridades de los problemas de salud allí atendidos, así como las estrategias a seguir para el diagnóstico. Se hacen las consideraciones finales sobre el tema, y se enfatiza que el uso adecuado del método clínico es el principal recurso que posee el médico para identificar los problemas de salud que enfrenta en la atención primaria.

The medical diagnosis is the base of an appropriate care to our patients. A review of national literature and of some foreign papers on the clinical method was conducted, its significance, bases, procedures and major features in primary care emphasizing on the morbidity at that care level, the particular characteristics of the health problems approached, as well as the strategies to be followed for the diagnosis. The final considerations on this subject are made emphasizing that the appropriate use of clinical method is the main resource to count on the physician to identify the health problems faced in the primary care.

Use of Google as a Diagnostic Aid / 대한간학회지

No abstract available.

Development of a Problem-oriented Simulation System for Medical Diagnosis / 医学教育

We developed a problem-oriented simulation system for medical diagnosis which works on personal computers without special equipment. In this simulation system the history of illness can be presented by voice, and physical findings are presented audiovisually through the student's actions, in a manner that closely resembles an actual medical examination. The laboratory findings are also presented through the student's actions. Students compile a database with information that they collect, create a problem list, and devise an initial diagnostic plan for the patient's most important problem. This computer-assisted system will help medical students learn diagnostic strategies in a simulated clinical setting. We believe that this system is a promising method that will facilitate problem-oriented learning in the virtual multimedia environment with special convenience for medical students to share time and facilities and to lower costs.

An Ethical Review on Medical Diagnosis and Treatment of Schizophrenia / 中国医学伦理学

By summarizing the features of medical diagnosis and treatment of schizophrenia,this article mainly analyzes the ethical disfigurement and relevant harm,discusses the ethical principles and requirement which doctors and nurses should abide by during the whole medical course,so that doctors' ethical diathesis can be improved,and a harmonious physician-patient relationship can be achieved.

The application of data mining technology based on rough sets to medical diagnosis / 医疗卫生装备

Rough set is a mathematical approach to study imprecise, uncertain or incomplete information or knowledge. The data mining technology based on the rough set theory can be trained through the training data set. The technology is applied to such fields as the prognosis of the pain in the chest, emergence diagnosis in ICU, distinguishing and diagnosis of lung tumor and rheumatoid disease, diagnosis of galactophore disease, diagnosis of premature birth, classification and diagnosis of liver disease and acute appendicitis. The technology has a brilliant future in medical data mining.