Three paradoxes of medical diagnosis

Sadegh-zadeh [23] has proposed a theory of the relativity of medical diagnosis in terms of the time at which a diagnosis is accepted, the patient to whom the diagnosis applies, the physician who renders the diagnosis, the medical knowledge used, the diagnostic method applied, and the set of patient observations. Use of classical formal logic as the ‘diagnostic method’ may result in three paradoxes: the paradoxes of consistency, completeness, and justifiable ignorance. These paradoxes may be resolved by the addition of two non-classical operators, the ‘certainty’ and ‘effort’ operators, akin to the non-classical operators of modal logic.     

Support groups for medical caregivers of people with HIV diseases

As we enter the second decade of AIDS, medical caregivers are experiencing stress and burnout as a result of their work with people with HIV diseases. There are common themes to the stress, as well as differences in the experience of stress according to the characteristics of the healthcare setting. Caregiver support groups are a means of reducing this stress by helping medical caregivers cope better, manage difficult cases, normalize their feelings, put understanding and context to their experiences, decrease isolation, and instill meaning in their work. The use of support groups across various medical settings is presented.The author wishes to acknowledge the assistance of Nicholas Covino, Ph.D., Peter Kassel, Psy.D., Randall Paulsen, M.D., Veronica Rempusheski, Ph.D., Dan Silverman, M.D., and Susan Burns Tisdale, R.N., in ongoing research regarding caregiver support groups. The author also wishes to express gratitude to Genya Bernstein, Psy.D., for many editorial contributions.     

Modeling medical diagnosis: Logical and computer approaches

Conclusion In the present article I have surveyed several approaches to modeling the clinical diagnostic process. I have argued that at this point of the field's development, logics which simulate the reasoning patterns and knowledge base of expert clinicians represent research programs that are most likely to succeed. No logic of diagnosis has yet attained the status of being definitive; in spite of striking progress much more research and testing is required. On the basis of various existing logics, I have attempted to articulate a number of desiderata which an ideal diagnostic logic should satisfy. In spite of these criticisms, I would maintain that programs such as MYCIN and INTERNIST have already matured to the point where they are useful both in consultations and in teaching diagnostic reasoning.Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, PA 15260. The author wishes to acknowledge gratefully the assistance of Drs. Jack D. Myers, Harry E. Pople, Jr., Joshua Nagin, and Randy Miller with the research that resulted in this essay and thanks to L. J. Cohen, J. F. Fries, R. N. Giere, and C. Whitbeck for comments on an earlier draft. Supported in part by training grant MB 00199-01 from the Bureau of Health Manpower (DHEW) and by the National Science Foundation and the National Endowment for the Humanities.Presented at a symposium on Philosophy and Medicine held at the American Philosophical Association's Eastern Division Meeting in Washington, D.C., December 27–29, 1978. This essay partially overlaps with an article on Problems in computer diagnosis to appear inThe Ethics of Diagnosis, H. T. Engelhardt, Jr. and S. Spicker (eds.) Dordrecht: D. Reidel, forthcoming.     

Aspects of process diagnosis in the psychotherapy of psychosomatic diseases

15 patients with psychosomatic diseases and the phenomenon of alexithymia, together with neurotic patients are treated psychotherapeutically in half-open groups. Contrary to the neurotics the patients show some special features regarding the process diagnostics. In assessing the wished and really experienced nearness to the group members there is a deficient ability to differentiate. During the therapeutic process the intrapsychic tension (EMI - Inventory of Emotionalities) is subject to great fluctuations or doesn't change. The occurrence of fluctuations in the EMI and of greater differentiations in the N-D-Test (Nearness-Distance-Test) suggest a good prognosis. A therapy of psychosomatic patients together with neurotic patients seems to be more effective than the treatment in homogeneous groups.     

内科急症腹痛诊断的临床思维误区

急症腹痛是内科急诊患者最常见的主诉之一,具有发病急、变化快、病因复杂隐匿等特点,临床上极易误诊.本文从急症腹痛诊断思维活动的主观性、局限性、静止和片面性以及思维活动的教条性、惰性等角度深入探讨了急症腹痛误诊的常见临床思维误区.     

内科急症腹痛诊断的临床思维误区

急症腹痛是内科急诊患者最常见的主诉之一,具有发病急、变化快、病因复杂隐匿等特点,临床上极易误诊。本文从急症腹痛诊断思维活动的主观性、局限性、静止和片面性以及思维活动的教条性、惰性等角度深入探讨了急症腹痛误诊的常见临床思维误区。     

The current role of neurosyphilis in the differential diagnosis of neuropsychiatric diseases

Over a period of eight years, 16 patients from a non-selected number of patients in a neuropsychiatric special hospital were diagnosed to suffer from neurolues not known so far. Apart from the classical clinical pictures (PP and T. d.) meningovascular courses of disease with apoplectiform onset have been dominant since 1980. The patients concerned were nearly exclusively younger male adolescents. The decline in the classical development of neurolues in favour of meningovascular and atypical clinical pictures makes clinical diagnosis more difficult and requires routine application of standardized specific and serological tests in clinical practice.     

Foundations of clinical praxiology part I: The relativity of medical diagnosis

The question is raised whether it would be beneficial to establish a clinical praxiology for the sake of a multi-focused inquiry into the foundations of clinical pratice. Beginning with the concept of medical diagnosis, a framework is presented which makes it possible to view diagnosis as an element of a complex structure whose adequate analysis requires at least comparative diagnostic methodology and epistemology.     

过敏调控--对过敏性疾病诊治的理性思考

在分析我国过敏性疾病诊治现状的基础上,结合我国和国际上过敏性疾病发病率逐年增高的发展趋势,建议对过敏性疾病的诊治和防范,应规范诊疗常规、加强科普宣教、普及环境预报、综合传统疗法、完善自我预警,实现群体抗敏等对策.     

一个不可回避的事实--无法干预性疾病早期诊断的悖论

在疾病的早期诊断中,无法干预性疾病以其疾病的不治性使得早期诊断失去了存在的意义和价值;然而从动态的发展角度观察,早期诊断和无法干预性疾病却又具有统一性.这种看似矛盾其实统一的悖论是当前临床医疗中普遍存在而又不可回避的一个现实问题.     

Legal aspects of traumatic cerebrovascular lesions

The paper opens with an account of what may be entailed in traumatic damage to cerebral vessels and cervical vessels, and its pathomechanism. There follows an account of two cases involving traumatic cerebral infarction and the resulting problems for the expert witness. Ascertainment of the relationship between external trauma and cerebral infarction depends on the nature and degree of the traumatic violence (precise trauma anamnesis), the reaction of the organism thereto, and the seriousness of previous complaints (arteriosclerosis, causes of cerebral embolism).     

On the relation between base-rate and cost-benefit learning in simulated medical diagnosis.

Observers completed a series of simulated medical diagnosis tasks that differed in category discriminability and base-rate/cost-benefit ratio. Point, accuracy, and decision criterion estimates were closer to optimal (a) for category d' = 2.2 than for category d' = 1.0 or 3.2, (b) when base-rates as opposed to cost-benefits were manipulated, and (c) when the cost of an incorrect response resulted in no point loss (nonnegative cost) as opposed to a point loss (negative cost). These results support the "flat-maxima" and competition between reward and accuracy (COBRA) hypotheses. A hybrid model that instantiated simultaneously both hypotheses was applied to the data. The model parameters indicated that (a) the reward-maximizing decision criterion quickly approached the optimal criterion, (b) the importance placed on accuracy maximization early in learning was larger when the cost of an incorrect response was negative as opposed to nonnegative, and (c) by the end of training the importance placed on accuracy was equal for negative and nonnegative costs.     

Clinical multiplicity of cerebrovascular disorders in childhood

A group of 107 children with vascular diseases of the nervous system aged 3-14 years have been studied. In 100 children of the study group acute disturbances of the brain blood circulation have been found, out of which 37 children were with transitory ischemic attacks; 29 were found to be with brain ischaemia; 22-with haemorrhages (7 cases with subarchnoidal, 9 cases with intracerebral and 6 cases with subarachnoidal-parenchimatose); 5 children had wenous thromboses; 7 children were with spinal strokes. In other 7 children we found the presence of Sturge-Weber syndrome. Congenital vascular malformations have been found in 32 children (30%), out of which 16 children (15%) with loops and stenosis of the extracranial segments of the internal carotid artery, and another 16 children (15%) with AV-malformations. Congenital and acquired heart diseases are found to be primary cause for the strokes in 12 children (11%). Considerable is the rate of the epileptic seizures in the acute stage of the strokes as well as of the residual epileptic syndromes.