Construcción de recursos de texto para la identificación automática de información clínica en narrativas no estructuradas / Construction of text resources for automatic identification of clinical information in unstructured narratives

Background: A significant proportion of the clinical record is in free text format, making it difficult to extract key information and make secondary use of patient data. Automatic detection of information within narratives initially requires humans, following specific protocols and rules, to identify medical entities of interest. Aim: To build a linguistic resource of annotated medical entities on texts produced in Chilean hospitals. Material and Methods: A clinical corpus was constructed using 150 referrals in public hospitals. Three annotators identified six medical entities: clinical findings, diagnoses, body parts, medications, abbreviations, and family members. An annotation scheme was designed, and an iterative approach to train the annotators was applied. The F1-Score metric was used to assess the progress of the annotator's agreement during their training. Results: An average F1-Score of 0.73 was observed at the beginning of the project. After the training period, it increased to 0.87. Annotation of clinical findings and body parts showed significant discrepancy, while abbreviations, medications, and family members showed high agreement. Conclusions: A linguistic resource with annotated medical entities on texts produced in Chilean hospitals was built and made available, working with annotators related to medicine. The iterative annotation approach allowed us to improve performance metrics. The corpus and annotation protocols will be released to the research community.

Invisibilidad del adulto mayor con VIH/SIDA: La percepción del médico de atención primaria en Tabasco (México) / Invisibility of older adults with HIV/AIDS: The primary care physician's perception in Tabasco (Mexico)

RESUMEN Objetivo: Interpretar la percepción de los médicos de atención primaria sobre las condiciones sociales y sanitarias que intervienen en la invisibilidad del paciente adulto mayor con VIH/SIDA en Tabasco (México). Materiales y métodos: Bajo el enfoque de teoría fundamentada se realizó un estudio cualitativo durante agosto de 2018. Se formó un grupo focal integrado por médicos tratantes de diversas instituciones del sistema de salud. Se empleó una guía de entrevista y para su análisis se utilizó el software MAXQDA versión 2018.2. Resultados: La invisibilidad del paciente adulto mayor en el ámbito sanitario se refleja en las limitaciones institucionales relacionadas con el tiempo de atención que no facilitan la labor del médico para reconocer los aspectos clínicos y emocionales. Otro factor es la hegemonía médica que no permite tomar en cuenta la opinión del enfermo y no explora la existencia de la práctica sexual en esa fase de la vida. Ambos aspectos son condicionantes de un diagnóstico tardío de VIH/SIDA. Conclusiones: El constante aumento de adultos mayores infectados y la expansión geográfica de la enfermedad deben ser indicadores potenciales para los gestores y profesiones de salud para establecer prioridades en la atención y el control del VIH/SIDA.

ABSTRACT Objective: To read into the perception of primary care physicians about the social and sanitary conditions which deals with the older adults patient invisibility with AIDS in Tabasco (México). Materials and methods: Focusing through the sustained theory a qualitative study was done during August 2018. A focal group integrated of treating physicians from different Health Systems institutions was formed. It was used an interview guide and it was also used the MAXQDA software version 2018.2 for analysing it. Results: The invisibility of the older adult patients in the sanitary scope is reflected in the institutional related limitations with the care time which do not facilitate the physicians work to recognize the clinical and emotional aspects. Another factor is the physician hegemony that does not allow to take into account the opinion of the patient and does not explore the existence of sexual practice in this phase of life. Both aspects are condition of HIV/AIDS late diagnosis. Conclusions: The constant older adults infected increase and the geographic expansion of the sickness, must be potential indicators to health professionals and promoters to establish priorities in HIV/AIDS attention and control.

Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador / Incorporación de los derechos humanos a los programas de formación de los proveedores de atención de salud reproductiva en Nicaragua y El Salvador

Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights - related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care.

Los proveedores de atención sanitaria desempeñan una función esencial en la promoción y la protección de los derechos humanos en la atención al paciente. En consecuencia, la Asociación Médica Mundial, entre otras instituciones, ha exhortado a las facultades de medicina y de enfermería a incorporar la formación en materia de derechos humanos en sus programas de capacitación. Este informe describe las iniciativas de una organización no gubernamental centroamericana para que se introduzcan contenidos relacionados con los derechos humanos en los programas de capacitación de los proveedores de atención de salud reproductiva en Nicaragua y El Salvador. Las conclusiones iniciales indican que no se prepara adecuadamente a los proveedores de atención de salud para cumplir su responsabilidad de proteger y promover los derechos humanos en la atención al paciente. Los administradores de las facultades de medicina y de enfermería, el profesorado y los estudiantes reconocen la necesidad de fortalecer la capacitación en esta área y son entusiastas acerca de incorporar contenidos relacionados con los derechos humanos en sus programas de formación. Los resultados de la evaluación indican que la exposición a materiales y métodos didácticos que subrayen la relación entre los derechos humanos y la salud reproductiva puede conducir a cambios en las actitudes y los comportamientos de los proveedores de atención de salud que contribuyan a promover y proteger los derechos humanos en la atención al paciente.