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      Diagnósticos clínicos al ingreso y al egreso de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos Translated title: Clinical diagnoses in admission and in discharge of patients admitted to Internal Medicine, Geriatrics and Infection wards

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          Abstract

          A partir de asumir que una coincidencia entre el diagnóstico inicial al ingreso y el definitivo al egreso, refleja alta calidad en el cumplimiento de ese paso esencial del método clínico, se revisaron los resultados de dos series de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos, para precisar factores asociados con dicha correspondencia. Se constató total coincidencia en más de las dos terceras partes de los casos, con porcentajes elevados en los más jóvenes, los que tuvieron menor estadía y los que ingresaron en el horario de las guardias. Se destacan los altos valores para enfermedades respiratorias e infecciosas y más bajos para diagnósticos menos precisos, como anemias, síntomas y signos mal definidos y para los ingresados en Geriatría. Se hacen consideraciones sobre el error diagnóstico y la trascendencia de estos resultados para los pacientes y la organización de la atención hospitalaria.

          Translated abstract

          The assumption that there is a coincidence between the initial diagnosis at admission and the definite at discharge reflects a high quality in fulfillment of this essential step of clinical method. Results from two series of patients admitted in Internal Medicine, Geriatrics and infectiuos diseases departments were reviewed to specify exactly the factors associated with such correspondence. Authors verified the total coincidence in more than the two third of cases with high percentages in younger, which had a minor stage and those admitted in the medical duty times. Emphasized are the higher values for the respiratory and infectious diseases and lower for fewer accurate diagnoses including anemias, ill-defined symptoms and signs and for those admitted in Geriatrics department. We took into account on the diagnostic error and the importance of these results for patients and the organization of hospital care.

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          Most cited references47

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          Early diagnosis of myocardial infarction with sensitive cardiac troponin assays.

          The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need. We conducted a multicenter study to examine the diagnostic accuracy of new, sensitive cardiac troponin assays performed on blood samples obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infarction. Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard assay (Roche Troponin T). The final diagnosis was adjudicated by two independent cardiologists. Acute myocardial infarction was the adjudicated final diagnosis in 123 patients (17%). The diagnostic accuracy of measurements obtained at presentation, as quantified by the area under the receiver-operating-characteristic curve (AUC), was significantly higher with the four sensitive cardiac troponin assays than with the standard assay (AUC for Abbott-Architect Troponin I, 0.96; 95% confidence interval [CI], 0.94 to 0.98; for Roche High-Sensitive Troponin T, 0.96; 95% CI, 0.94 to 0.98; for Roche Troponin I, 0.95; 95% CI, 0.92 to 0.97; and for Siemens Troponin I Ultra, 0.96; 95% CI, 0.94 to 0.98; vs. AUC for the standard assay, 0.90; 95% CI, 0.86 to 0.94). Among patients who presented within 3 hours after the onset of chest pain, the AUCs were 0.93 (95% CI, 0.88 to 0.99), 0.92 (95% CI, 0.87 to 0.97), 0.92 (95% CI, 0.86 to 0.99), and 0.94 (95% CI, 0.90 to 0.98) for the sensitive assays, respectively, and 0.76 (95% CI, 0.64 to 0.88) for the standard assay. We did not assess the effect of the sensitive troponin assays on clinical management. The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain. (ClinicalTrials.gov number, NCT00470587.) 2009 Massachusetts Medical Society
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            El método clínico: muerte y resurrección

            Se presenta una reflexión acerca de la pertinencia y actualidad del método clínico, entendido como el proceso del diagnóstico inherente a la medicina práctica humana. Se enuncian consideraciones epistemológicas acerca de la naturaleza científica del método clínico, la taxonomía en la medicina y los "tipos cardinales" del diagnóstico diferencial. Se analiza el proceso del diagnóstico desde la perspectiva de los procesos lógicos, en particular el método hipotético deductivo. Se aborda la activación, refinamiento y evaluación de hipótesis como mecanismos operantes en el proceso del diagnóstico. Se hacen consideraciones respecto al impacto de la tecnología computacional y la adaptación a la misma del método clínico, que resulta enriquecido en vez de empobrecido. Finalmente se valora la pertinencia de una transformación del método clínico, por efecto de la emergencia de un nuevo paradigma de la medicina más expansivo y extensivo, con un basamento hermenéutico del significado y la interpretación del diagnóstico, con el ser humano como eje central y la medicina como ciencia humana y práctica.
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              Fatigue, alcohol and performance impairment.

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                Author and article information

                Journal
                med
                Revista Cubana de Medicina
                Rev. Cuban de Med
                Centro Nacional de Información de Ciencias Médicas; Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0034-7523
                1561-302X
                June 2010
                : 49
                : 2
                Affiliations
                [01] Cienfuegos orgnameHospital Universitario Dr. Gustavo Aldereguía Lima Cuba
                Article
                S0034-75232010000200004 S0034-7523(10)04900204
                d41b51b1-ec60-49d7-af65-444cf969e64a

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 16 November 2009
                : 30 October 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 47, Pages: 0
                Product

                SciELO Cuba

                Categories
                ARTICULOS ORIGINALES

                ingreso-egreso,admission-discharge,Diagnóstico,error diagnóstico,diagnostic error,Diagnosis,pacientes hospitalizados,admitted patients

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