Tunnel vision and diagnostic error
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An 65-year-old man went to the hospital with cough and coughing up blood. An x-ray showed signs of lung cancer. While at the hospital, the man also complained of severe foot pain but the doctor focused only on the lung issue. 24 hours later, the man was found to have poor blood circulation in his leg and foot but an intervention procedure did not turn out well. The case demonstrates "tunnel vision" where the doctor failed to properly examine the patient's other symptoms like foot pain due to being focused only on the lung cancer, leading to missed diagnosis of a related vascular problem.
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COACHING en la Decisión en Medicina
Este documento presenta una ponencia sobre la aplicación del coaching en el proceso de diagnóstico médico. Explica que el coaching puede utilizarse mediante técnicas como el modelo GROW, el reconocimiento de la singularidad del paciente, y hacer preguntas efectivas durante la anamnesis y examen físico. También describe cómo el coaching puede beneficiar al médico al mejorar sus habilidades a través de sesiones de coaching y prácticas como la meditación. El objetivo final es que los médicos puedan tomar decisiones más informadas y ayudar a cada
Estrategias de decision
Este documento presenta varias estrategias para tomar buenas decisiones en la práctica clínica. Algunas estrategias clave incluyen utilizar la prevalencia de condiciones, seleccionar signos y síntomas clave, organizar la información en "nodos", conocer los sesgos del razonamiento automático y aprender de los errores para mejorar el razonamiento clínico a través del tiempo. El documento también describe los elementos de una buena decisión clínica y un proceso de comprobación para el diagnóstico médico.
Melanoma and HIV: is there an increase in incidence?
There is an increased incidence of melanoma in HIV patients compared to the general population. The incidence is 26-28% higher in the pre-HAART era and remains elevated at 26-50% even after the introduction of HAART treatment. While immune deficits associated with HIV increase cancer risks, clinical trials often exclude HIV patients with melanoma. However, treatment of melanoma in HIV patients with a high CD4 count, low viral load, no other illnesses, and slow disease progression may have outcomes similar to HIV-negative patients.
Ipilimumab and BRAF inhibitors cutaneous toxicity
This document summarizes treatment guidelines for squamous carcinoma and vemurafenib. It discusses surgery and radiotherapy options, as well as adjuvant and metastatic treatment settings. For metastatic melanoma, it outlines treatment options based on performance status, organ involvement, and BRAF mutation status, including chemotherapy, immunotherapy, targeted therapy, and palliative care. It also summarizes toxicity profiles of vemurafenib and dabrafenib, including common side effects like arthralgia, rash, and keratoacanthoma skin lesions.
Melanoma genetics and treatment
This document summarizes genetic markers and targeted therapies for melanoma. It notes that BRAF mutations are present in 40-70% of melanomas and that drugs like vemurafenib and dabrafenib that target mutated BRAF have shown improved survival compared to chemotherapy in clinical trials. For melanomas with NRAS or KIT mutations, drugs targeting the MEK pathway or KIT, respectively, are under investigation. The document also reviews genetic markers and potential targeted therapies for different anatomical sites of melanoma like the skin, mucosa, and uveal melanoma.
MejoranoviembrMejora del Diagnostico
Este documento discute cómo mejorar el razonamiento clínico y la toma de decisiones en medicina. Explica que los médicos a veces se equivocan en el diagnóstico debido a sesgos cognitivos, entrada de información inadecuada, procesamiento incorrecto de datos o falta de verificación. Propone realizar ejercicios con casos clínicos y discutir aspectos del sistema de salud que afectan el diagnóstico, para reconocer y corregir sesgos y mejorar el razonamiento.
II Workshop Foro Osler: la importancia del sistema: circuito de test diagnóst...
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Receptor discordance refers to changes in the status of hormone receptors (estrogen receptor ERα, progesterone receptor PgR, and HER2) in breast cancer tumors over time or between primary and metastatic sites.
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Tunnel vision and diagnostic error
- 1. “Visión de túnel”/ Tunnel vision
- 2. Clinical case • An 65 years old man went to the hospital with cough and hemoptisis. An X-Ray showed a pulmonary image compatible with lung cancer. • The patient stayed at the hospital for bronchoscopy and the doctor wrote that he was also having strong foot pain. • 24 hours later arterial ischemia was detected and the patient suffered an intervention but with bad outcome.
- 3. Case analysis • Tunnel vision: the doctor didn,t paid enough attention to foot pain, because the image at the lung keep all his efforts. This concept is closely related to “premature closing” because the incomplete evaluation of data of the patient. • Bad communication, specialization and incomplete clinical evaluation, are at the base of this situation.
- 4. Etiology and clinical examination Foot pain
- 5. Foot pain •Muscles and bones. •Neurogénic. •Vascular.
- 6. DOLOR PIE • Muscle and bones: hyperuricemia
- 7. Foot Pain • Neurogénic: Diabetic neuropathy
- 8. Foot Pain • Vascular: celulitis, Deep Venous thrombosis, arterial ischemia.
- 9. Pedial pulse
- 10. Tibial pulse
- 11. Popliteal pulse