Los modelos biomedico y biopsicosocial en medicina / Biomedical and biopsychosocial models in medicine

Se introduce el concepto de modelos en la ciencia y práctica médicas. Se analizan dos modelos vigentes en la medicina contemporánea: el modelo "biomédico" (MBM), actualmente predominante, y el modelo bio-psico-social (MBPS), que cuestiona el reduccionismo del primero. Se revisa la historia y contenido conceptual de ambos. Se revisa la "teoría general de sistemas" como referente de ambos modelos. Se introduce el ''modelo centrado en el paciente" como práctica dialógica.

The concept of models in medical science and practice is introduced. Two current models in contemporary medicine are analyzed: the "biomedical" model (MBM), currently predominant, and the bio-psycho-social model (MBPS), which questions the reductionism of the former. The history and conceptual content of both are reviewed. The "general systems theory" is reviewed as a reference for both models. The "patient-centered model" is introduced as a dialogic practice.

Imagine all you want, but .

3D printing is an emerging trend in medical care [1]. Medical libraries can play a key role in advancing this new technology [2]. Using a National Library of Medicine (NLM) grant, the medical library was able to purchase a basic 3D printer to create models for patient care and medical education. Despite a slow rollout for the new technology, there was a strong need once word of mouth spread about the new 3D printer. The one-year grant cycle, as well as the following three years, provide supporting evidence that even a basic 3D printer can advance patient care for clinicians and improve medical education for students [3]. The popularity of the technology, clinical support and demand, as well as student interest can drive the program forward on its own and support the medical library's mission to improve community care and create an environment of enhanced learning [1].

Photograph as Skin, Skin as Wax: Indexicality and the Visualisation of Syphilis in Fin-de-Siècle France The William Bynum Prize Essay.

In early twentieth-century France, syphilis and its controversial status as a hereditary disease reigned as a chief concern for physicians and public health officials. As syphilis primarily presented visually on the surface of the skin, its study fell within the realms of both dermatologists and venereologists, who relied heavily on visual evidence in their detection, diagnosis, and treatment of the disease. Thus, in educational textbooks, atlases, and medical models, accurately reproducing the visible signposts of syphilis - the colour, texture, and patterns of primary chancres or secondary rashes - was of preeminent importance. Photography, with its potential claims to mechanical objectivity, would seem to provide the logical tool for such representations. Yet photography's relationship to syphilographie warrants further unpacking. Despite the rise of a desire for mechanical objectivity charted in the late nineteenth century, artist-produced, three-dimensional, wax-cast moulages coexisted with photographs as significant educational tools for dermatologists; at times, these models were further mediated through photographic reproduction in texts. Additionally, the rise of phototherapy complicated this relationship by fostering the clinical equation of the light-sensitive photographic plate with the patient's skin, which became the photographic record of disease and successful treatment. This paper explores these complexities to delineate a more nuanced understanding of objectivity vis-à-vis photography and syphilis. Rather than a desire to produce an unbiased image, fin-de-siècle dermatologists marshalled the photographic to exploit the verbal and visual rhetoric of objectivity, authority, and persuasion inextricably linked to culturally constructed understandings of the photograph. This rhetoric was often couched in the Peircean concept of indexicality, which physicians formulated through the language of witness, testimony, and direct connection.

How general practitioners understand and handle medically unexplained symptoms: a focus group study.

BACKGROUND: Medically unexplained symptoms (MUS) are a common yet challenging encounter in primary care. The aim of this study was to explore how general practitioners (GPs) understand and handle MUS. METHODS: Three focus group interviews were conducted with a total of 23 GPs. Participants with varied clinical experience were purposively recruited. The data were analysed thematically, using the concept of framing as an analytical lens. RESULTS: The GPs alternated between a biomedical frame, centred on disease, and a biopsychosocial frame, centred on the sick person. Each frame shaped the GPs' understanding and handling of MUS. The biomedical frame emphasised the lack of objective evidence, problematized subjective patient testimony, and manifested feelings of uncertainty, doubt and powerlessness. This in turn complicated patient handling. In contrast, the biopsychosocial frame emphasised clinical experience, turned patient testimony into a valuable source of information, and manifested feelings of confidence and competence. This in turn made them feel empowered. The GPs with the least experience relied more on the biomedical frame, whereas their more seasoned seniors relied mostly on the biopsychosocial frame. CONCLUSION: The biopsychosocial frame helps GPs to understand and handle MUS better than the biomedical frame does. Medical students should spend more time learning biopsychosocial medicine, and to integrate the clinical knowledge of their peers with their own.

Application of 3D printing models in undergraduate medical imaging teaching / 中华医学教育探索杂志

Objective To evaluate the effect of 3D printing models applied to Medical Imaging Di-agnosis Undergraduate Teaching. Methods Students in the year 2012/2013 of Shanghai Jiao Tong Univer-sity School of Medicine stomatology specialty were chosen for this study, including 38 students in the exper-imental group (2013) and 40 students in the control group (2012). All of them were taught by the same group of teachers, including 28 core curriculum hours and 5 practice class hours. 3D printing technology with PPT was applied to the experimental group in the medical imaging diagnostic teaching, and conventional teaching including PPT and usual models in the control group. Medical students were given a test about cardiovascular system and tasked with completion of drawing hand and foot bones. Students in experimental group were also asked to complete a questionnaire about their experience. Results The questionnaire showed that 3D printing teaching molds with PPT was of great significance to improve the students interest in learning imaging anatomy, to meet the vast majority of students' learning requirements, and to achieve satis-factory results. The average scores of the circulatory system test in the experimental group were higher than that of the control group [(8.32 ±2.352) vs. (6.15 ±1.284), P<0.05)]. Students in experimental group per-formed better than students in the control group on the Locomotor system test [(6.81 ±1.347] vs. (3.84 ± 0.985), P<0.01]. Conclusions 3D printing mold combined with PPT teaching method can promote the med-ical imaging anatomy structure, learning effect and teaching quality, and has practical value in the under-graduate teaching of medical imaging diagnosis.

La autoatención y el enfoque relacional / Self-care and the relational approach

El articulo caracteriza y reflexiona sobre el modelo de autoatención y su relación con los otros modelos médicos. A partir de la obra de Eduardo Luis Menéndez, presenta el desarrollo problemático de las concepciones de actor, estructura social y sujeto con sus respectivas relaciones, y expone los rasgos más importantes del enfoque relacional como metodología de abordaje de lo que se denomina antropología médica. Desde la perspectiva antropológica de dicho autor existen saberes, formas de atención y prevención de los sufrimientos físicos y mentales que no adscriben al modelo biomédico y que, sin embargo, mentales que no adscriben al modelo biomédico y que, sin embargo, son utilizados con mucha frecuencia por las poblaciones a los fines de prevenir, aliviar y/o curar los mismos. Reconocer esta diversidad es, rescatar y hacer visible una modalidad de abordaje del sufrimiento, que amalgama diferentes formas de atención biomédicas y alternativas a las que se denomina “autoatención”, que son frecuentemente negadas por la medicina científica y que se constituyen como el primer nivel de atención. Se propone el enfoque relacional como una metodología adecuada para el abordaje de la autoatención, por su capacidad de develar las perspectivas de los sujetos acerca de dichas prácticas.

The article characterizes and reflects on the model of self-care and its relationship with other medical models. Based on the work of Eduardo Luis Menéndez, it presents the problematic development of the concepts of actor, social structure and subject with their respective relationships, and exposes the most important features of the relational approach as a methodology for approaching what is called medical anthropology. From the anthropological perspective of this author there are knowledge, forms of care and prevention of physical and mental suffering that do not attach to the biomedical model and which, however, are very frequently used by populations in order to prevent, alleviate and/or cure them. To recognize this diversity is to rescue and make visible a way of approaching suffering, which amalgamates different forms of biomedical care and alternatives to what is called “self-care”, which are frequently denied by scientific medicine, and which constitute the first level of care. The relational approach is proposed as an adequate methodology for the approach of self-care, given its ability to reveal the perspectives of subjects about such practices.

A Pathophysiological Model-Driven Communication for Dynamic Distributed Medical Best Practice Guidance Systems.

There is a great divide between rural and urban areas, particularly in medical emergency care. Although medical best practice guidelines exist and are in hospital handbooks, they are often lengthy and difficult to apply clinically. The challenges are exaggerated for doctors in rural areas and emergency medical technicians (EMT) during patient transport. In this paper, we propose the concept of distributed executable medical best practice guidance systems to assist adherence to best practice from the time that a patient first presents at a rural hospital, through diagnosis and ambulance transfer to arrival and treatment at a regional tertiary hospital center. We codify complex medical knowledge in the form of simplified distributed executable disease automata, from the thin automata at rural hospitals to the rich automata in the regional center hospitals. However, a main challenge is how to efficiently and safely synchronize distributed best practice models as the communication among medical facilities, devices, and professionals generates a large number of messages. This complex problem of patient diagnosis and transport from rural to center facility is also fraught with many uncertainties and changes resulting in a high degree of dynamism. A critically ill patient's medical conditions can change abruptly in addition to changes in the wireless bandwidth during the ambulance transfer. Such dynamics have yet to be addressed in existing literature on telemedicine. To address this situation, we propose a pathophysiological model-driven message exchange communication architecture that ensures the real-time and dynamic requirements of synchronization among distributed emergency best practice models are met in a reliable and safe manner. Taking the signs, symptoms, and progress of stroke patients transported across a geographically distributed healthcare network as the motivating use case, we implement our communication system and apply it to our developed best practice automata using laboratory simulations. Our proof-of-concept experiments shows there is potential for the use of our system in a wide variety of domains.

Use of prototyping in preoperative planning for patients with head and neck tumors.

BACKGROUND: Prototyping technologies for reconstructions consist of obtaining a 3-dimensional model of the object of interest. Solid models are constructed by the deposition of materials in successive layers. The purpose of this study was to perform a double-blind, randomized, prospective study to evaluate the efficacy of prototype use in head and neck surgeries. METHODS: Thirty-seven cases were randomized into prototype and nonprototype groups. The following factors were recorded: the time of plate and locking screw apposition, flap size, time for reconstruction, and an aesthetic evaluation. RESULTS: The prototype group exhibited a reduced surgical time (43.7 minutes vs 127.7 minutes, respectively; p = .001), a tendency to reduce the size of the bone flap taken for reconstruction, and better aesthetic results than the group that was not prototyped. CONCLUSION: The use of prototyping demonstrated a trend toward a reduced surgical time, smaller bone flaps, and better aesthetic results.

La homeopatía a través de la mirada de la alopatía / Homeopathy through the eyes of allopathy

Desde su origen, la Homeopatía ha sido objeto de críticas por parte del modelo médico convencional, debido a que la metodología y los principios en que se fundamenta el arte curativo que configuró Samuel Hahnemann no son compartidos por el paradigma dominante, el cual se basa en el pensamiento positivista que se impuso en la segunda mitad del siglo XIX. Así, aunque ha pasado más de un siglo y a pesar de que la Homeopatía ha mostrado su efectividad cuando se aplica correctamente, la percepción de la mayoría de los médicos que ejercen la alopatía sigue en el presente las mismaspautas ideológicas de hace décadas. Esto pudo comprobarse a través de una seriede entrevistas con un grupo de médicos mexicanos elegidos al azar, quienes mostraron que los prejuicios y las descalificaciones hacia la medicina homeopática siguen presentes, aunque también se encontró cierta apertura en algunos de estosespecialistas. (AU)

Since its inception, homeopathy has been criticized by the conventional medical model, because the methodology and principles underlying the healing art that Samuel Hahnemann configured are not shared by the dominant paradigm, which is based on positivist thinking that prevailed in the second half of the nineteenth century. This way, although it has been more than a century and although homeopathy has shown its effectiveness when applied correctly, the perception of most doctors practicing allopathy follows in this the same guidelines ideological decades. This was proved through a series of interviews with a group of randomly selected Mexican physicians, who showed that the prejudices and insults towards homeopathic medicine are still present, but also found some open minds in some of these specialists. (AU)

La homeopatía a través de la mirada de la alopatía / Homeopathy through the eyes of allopathy

Desde su origen, la Homeopatía ha sido objeto de críticas por parte del modelo médico convencional, debido a que la metodología y los principios en que se fundamenta el arte curativo que configuró Samuel Hahnemann no son compartidos por el paradigma dominante, el cual se basa en el pensamiento positivista que se impuso en la segunda mitad del siglo XIX. Así, aunque ha pasado más de un siglo y a pesar de que la Homeopatía ha mostrado su efectividad cuando se aplica correctamente, la percepción de la mayoría de los médicos que ejercen la alopatía sigue en el presente las mismaspautas ideológicas de hace décadas. Esto pudo comprobarse a través de una seriede entrevistas con un grupo de médicos mexicanos elegidos al azar, quienes mostraron que los prejuicios y las descalificaciones hacia la medicina homeopática siguen presentes, aunque también se encontró cierta apertura en algunos de estosespecialistas.

Since its inception, homeopathy has been criticized by the conventional medical model, because the methodology and principles underlying the healing art that Samuel Hahnemann configured are not shared by the dominant paradigm, which is based on positivist thinking that prevailed in the second half of the nineteenth century. This way, although it has been more than a century and although homeopathy has shown its effectiveness when applied correctly, the perception of most doctors practicing allopathy follows in this the same guidelines ideological decades. This was proved through a series of interviews with a group of randomly selected Mexican physicians, who showed that the prejudices and insults towards homeopathic medicine are still present, but also found some open minds in some of these specialists.

Accuracy Tests of 3D Rapid Prototyping (RP) Medical Models: Its Potential and Clinical Applications

Presented in this paper are the experimental results that measure rapid prototyping (RP) errors in 3D medical models. We identified various factors that can cause dimensional errors when producing RP models, specifically in maxillofacial areas. For the experiment, we used a human dry skull. A number of linear measurements based on landmarks were first obtained on the skull. This was followed by CT scanning, 3D model reconstruction, and RP model fabrication. The landmarks were measured again on both the reconstructed models and the physical RP models, and these were compared with those on dry skull. We focused on major sources of errors, such as CT scanning, conversion from CT data to STL models, and RP model fabrication. The results show that the overall error from skull to RP is 0.64+/-0.36mm(0.71+/-0.66%) in absolute value. This indicates that the RP technology can be acceptable in the real clinical applications. A clinical case that has applied RP models successfully for treatment planning and surgical rehearsal is presented. Although the use of RP models is rare in the medical area yet, we believe RP is promising in that it has a great potential in developing new tools which can aid diagnosis, treatment planning, surgical rehearsal, education, and so on.

A Comparison of Clinicians'Roles in Different Medical Models / 中国医学伦理学

The Roles of the clinicians in different medical models are quite different,which not only led to the change of the relationship between the clinicians and the patients, but also had a significant clinical effect. The authors compared the clinicians'role in different medical models and showed the humanism underlying this change.