NEONATAL SEIZURES: NARRATIVE REVIEW

Neonatal seizures are often complex and difcult to recognize, but can be identied through electroencephalogram (EEG) monitoring. The Brighton Collaboration has developed a scheme with ve levels of diagnostic certainty to guide treatment decisions when EEG is not available. Different seizure types are usually associated with specic underlying causes, which may require specic diagnostic and treatment approaches. Neonatal seizures require prompt management, including the stabilization of cardiovascular and respiratory function and the identication of the underlying cause. EEG monitoring is considered essential for the detection of seizures and should be performed until the neonate has been seizure-free for 12 to 24 hours. Treatment involves the use of antiseizure medication and may include pyridoxine challenge or other treatment options such as the ketogenic diet, intravenous immunoglobulin, or corticosteroids if seizures are refractory to conventional antiseizure medication. It is important to differentiate between seizures and nonepileptic motor phenomena, which can occur without obvious cause or as symptoms of drug withdrawal, electrolyte abnormalities, hypoglycemia, or infection. Neuroimaging is also considered essential for the detection of possible structural abnormalities in neonates with seizures.

Reparación Directa y Conflicto Armado Interno: la Constitucionalización de la Responsabilidad Extracontractual del Estado / Direct Reparation and Internal Armed Conflict: Constitutionalization of Tort Liability of the State / Reparação Direta e Conflito Armado Interno: a Constitucionalização da Responsabilidade Ilícita do Estado

Resumen Introducción: En materia de responsabilidad extracontractual del Estado, los procesos de reparación directa que se han derivado de hechos con ocasión al Conflicto Armado Interno, en adelante -CAI- han generado cambios en las categorías de protección que se han ido transformando especialmente desde que se reconoce la existencia del CAI. Objetivo: el principal objetivo de esta investigación está articulado a determinar cuáles son las condiciones que se han valorado por parte del Consejo de Estado para establecer la adecuación frente a los títulos de imputación y asimismo, las condiciones de interpretación de las categorías del daño antijurídico y la responsabilidad del Estado. Materiales y Métodos: El estudio fue delimitado a partir de la revisión documental de una elección aleatoria de sentencias del Consejo de Estado tomadas de forma no probabilística a través de las categorías de los títulos de imputación que se presentaron en una reconstrucción cronológica donde el eje referencia se contrastó en una dimensión analítica del reconocimiento del CAI. Resultados: el estudio evidenció cómo entre los diferentes títulos de imputación aplicables a hechos del CAI existen parámetros que evidencian una transición de omisión institucional que permitía un margen de la concepción del daño antijurídico en un sentido amplio, hacia un margen más limitado fundamentado en un desarrollo más riguroso del principio de legalidad. Conclusiones: La declaración del CAI tuvo una gran incidencia en la forma como se desarrolló la responsabilidad extracontractual del Estado, que al disponer de nuevas categorías de protección generó con ello más seguridad jurídica, pero, que a su vez limitó interpretaciones amplias del daño antijurídico.

Abstract Introduction: In matters of extracontractual liability of the State, the processes of direct reparation that have been derived from facts on the occasion of the CAI have generated changes in the categories of protection that have been transforming especially since the existence of the CAI is recognized. Objective: The main objective of this research is to determine which are the conditions that have been assessed by the Council of State to establish the adequacy of the title of imputation and the conditions of interpretation of the categories of antijuridical damage and the responsibility of the State. Materials and Methods: The study was delimited from the documentary review of a random selection of sentences of the Council of State taken in a non-probabilistic way through the categories of the titles of imputation that were presented in a chronological reconstruction where the reference axis was contrasted in an analytical dimension of the recognition of the CAI. Results: the study evidenced how among the different titles of imputation applicable to facts of the internal armed conflict there are parameters that evidence a transition from institutional omission that allowed a margin of the conception of the antijuridical damage wide towards a more limited margin based on a more rigorous development of the principle of legality. Conclusions: The declaration of the internal armed conflict had a great impact on the way tort liability was developed, which by providing new categories of protection generated more legal certainty but limited broad interpretations of tort.

Resumo Introdução: Em matéria de responsabilidade extracontratual do Estado, os processos de reparação direta que foram derivados de fatos por ocasião da CAI geraram mudanças nas categorias de proteção que têm se transformado especialmente desde que a existência da CAI foi reconhecida. Objetivo: O principal objetivo desta pesquisa é determinar as condições que foram avaliadas pelo Conselho de Estado para estabelecer a adequação do título de imputação e as condições de interpretação das categorias de danos antijurídicos e a responsabilidade do Estado. Materiais e Métodos: O estudo foi delimitado a partir da revisão documental de uma seleção aleatória de julgamentos do Conselho de Estado tomados de forma não-probabilística através das categorias dos títulos de imputação que foram apresentados em uma reconstrução cronológica onde o eixo de referência foi contrastado em uma dimensão analítica do reconhecimento do CAI. Resultados: o estudo evidenciou como entre os diferentes títulos de imputação aplicáveis aos fatos do conflito armado interno existem parâmetros que evidenciam uma transição da omissão institucional que permitiu uma margem ampla da concepção de dano anti-jurídico para uma margem mais limitada baseada em um desenvolvimento mais rigoroso do princípio da legalidade. Conclusões: A declaração do conflito armado interno teve um grande impacto na forma como a responsabilidade extracontratual foi desenvolvida, o que ao proporcionar novas categorias de proteção gerou maior segurança jurídica, mas limitou interpretações amplas dos danos não judiciais.

Systematic reviews on interventions for COVID-19 have rarely graded the certainty of the evidence

ABSTRACT BACKGROUND: Numerous systematic reviews on coronavirus disease-19 (COVID-19) treatment have been developed to provide syntheses of the large volume of primary studies. However, the methodological quality of most of these reviews is questionable and the results provided may therefore present bias. OBJECTIVE: To investigate how many systematic reviews on the therapeutic or preventive options for COVID-19 assessed the certainty of the evidence through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. METHODS: We conducted a sensitive search in MEDLINE (via PubMed) and included all systematic reviews that assessed any intervention for COVID-19. The systematic reviews included were examined to identify any planned and/or actual assessment using the GRADE approach (or absence thereof) regarding the certainty of the evidence. RESULTS: We included 177 systematic reviews and found that only 37 (21%; 37/177) assessed and reported the certainty of the evidence using the GRADE approach. This number reduced to 27 (16.2%; 27/167) when Cochrane reviews (n = 10), in which an evaluation using GRADE is mandatory, were excluded. CONCLUSION: Most of the systematic reviews on interventions relating to COVID-19 omitted assessment of the certainty of the evidence. This is a critical methodological omission that must not be overlooked in further research, so as to improve the impact and usefulness of syntheses relating to COVID-19.

Transferência entre a crença e a certeza: contribuições ao diagnóstico / Transference between belief and certainty: contributions to the diagnosis

Freud insistia no papel do analista como aquele capaz de "pôr em movimento" um trabalho que aposta no inconsciente. Muito se discute sobre este papel da transferência, mas pretendemos abordá-la como uma ferramenta útil ao diagnostico diferencial, a partir do binômio crença/certeza. Sob a compreensão de que o diagnóstico em psicanálise se refere a mecanismos próprios a cada estrutura, nossa proposta é demonstrar este valor de ferramenta na clínica da neurose e da psicose, a partir do binômio crença/certeza. Logo, este artigo se propõe a realizar uma investigação que visa esclarecer as posições de crença e certeza, desveladas sob transferência, como aportes ao diagnostico diferencial. Desse modo, iremos percorrer as obras de Freud e de Lacan, auxiliados por seus comentadores e por autores contemporâneos que se dedicam ao tema. Nossa investigação permite-nos considerar que a relação do sujeito com o saber pode nos servir como importante índice clínico para a realização do diagnóstico diferencial. Em uma época marcada pela "descrença no saber inconsciente", cabe ao analista investigá-la em busca da distinção entre uma vacilação da crença, própria à neurose, e uma impossibilidade de crença, própria à psicose.(AU)

Freud had insisted in the role of psychoanalyst which one is capable for make one work in progress that bet on unconscious. Many discussions are about this role of transference, but we want to approach like one useful tool to differential diagnosis, from belief/certainty binomial. From the understanding that the diagnosis in psychoanalysis refers to mechanisms specific to each structure, our proposal is to demonstrate this tool value in the clinic of neurosis and psychosis, from the belief / certainty binomial. Therefore, this article proposes to carry out an investigation that aims to clarify the positions of belief and certainty, unveiled under transference, as contributions to the differential diagnosis. In this way, we will go through the works of Freud and Lacan, aided by their commentators and contemporary authors dedicated to the theme. Our research allows us to consider that the subject's relationship to knowledge can serve as an important clinical index to carry out the differential diagnosis. In an era marked by "unbelief in unconscious knowledge", it is up to the analyst investigates it in search of the distinction between a belief of hesitation, own neurosis, or a belief impossibility own psychosis.(AU)

La evaluación de riesgos en la prevención de enfermedades profesionales, incidentes y accidentes laborales en el cultivo intensivo de tilapia / The evaluation of risks in the disease prevention professional, incidental and occupational accidents in the intensive farming of tilapia

RESUMEN Introducción: el cuidado y preservación de la salud en los trabajadores es un factor clave para el incremento de la productividad, la sostenibilidad del trabajo realizado y el bienestar de todos sus empleados. El cultivo intensivo de la tilapia en Cuba es un proceso clave en la producción de alimentos saludables. Sin embargo, en esta actividad existen un conjunto de factores de riesgo que pueden provocar incidentes/accidentes laborales en las diferentes fases de su cultivo y que además pueden provocar enfermedades profesionales o comunes en los trabajadores involucrados. Objetivo: evaluar los factores de riesgos presentes en la actividad de cultivo intensivo de tilapia, desarrollada en una empresa pesquera. Materiales y métodos: e stán referidos a los tipos de investigación utilizados: exploratorios, descriptivos y explicativos. En cuanto a los métodos empíricos aplicados se incluyen la revisión bibliográfica, el método científico inductivo-deductivo y el análisis y la síntesis. Además de las herramientas propias del campo de investigación implicado (herramienta mapa del cuerpo y método binario de evaluación de riesgo). Resultados: s e identifican y evalúan los riesgos para la seguridad y salud de los trabajadores que laboran en el cultivo intensivo de la tilapia. Además, se identifican las principales dolencias en el cuerpo por la incidencia de las condiciones de trabajo y las tareas a desarrollar, considerando tres momentos: inicio, mediado y final de la jornada laboral. Se proponen las acciones preventivas a considerar para evitar problemas de salud, incidentes o accidentes laborales en función de las evaluaciones realizadas. Conclusiones: se destaca que el procedimiento utilizado y los resultados obtenidos constituyen una guía útil para las diferentes organizaciones que deseen conocer la incidencia que tienen los factores de riesgo encontrados en la salud de sus trabajadores, proponiendo un conjunto de medidas preventivas y correctivas para atenuar las situaciones desfavorables (AU).

ABSTRACT Introduction: care and preservation of the health in the workers is a key factor for the productivity improvement, the sustainability of the realized work and the well-being of all its employees. The intensive farming of the Tilapia in Cuba is a key process in the production of wholesome foods. However; In this activity there are a set of risk factors that incidents can provoke occupational accidents in the different phases of their cultivation and that besides they can provoke professional or common diseases in the implicated workers. Objective: evaluating the factors of present risks in the activity of intensive farming of Tilapia, developed in a fishing company. Materials and methods: they are referred to the types of investigation used: Exploratory, descriptive and explanatory. As to the empiric applied methods they include the bibliographic revision, the inductive deductive scientific method and the analysis and the synthesis. In addition to the own tools of the implicated line of research (tool map of the body and binary method of risk assessment). Results: they provide evidence of their identity and they evaluate security risks and health of the workers that labor in the intensive farming of the tilapia. Furthermore, provide evidence of their identity the main illnesses in the body for the incidence of the working conditions and the tasks to develop, considering three moments: Start, mediated and final of the workday. Actions for provisional remedy intend to consider to avoid health problems, incidents or occupational accidents in terms of the realized evaluations. Conclusions: he stands out that the used procedure and the obtained results constitute an useful guideline for the different organizations that they desire knowing the incidence that have the risk factors found in the health of their workers, proposing a set of measures preventive and corrective to attenuate the unfavorable situations (AU).

Evaluación de la calidad de la atención de Enfermería en el Servicio de Neonatología / Evaluation of the quality of Enfermería's attention in Neonatología's Service

RESUMEN Introducción: la Academia Americana de Pediatría define a los cuidados Intensivos como aquellos que recibe el recién nacido gravemente enfermo o los que requieren de una vigilancia estricta de los profesionales de la unidad neonatal. La calidad de la atención sanitaria es un atributo cada vez más valorado por todos los implicados en la atención a la salud (profesionales, usuarios y gestores) aunque cada uno de estos grupos enfatiza algunos aspectos en particular con relación al resto. Objetivo: evaluar la calidad de la atención de Enfermería en el Servicio de Neonatología. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en el Servicio de Neonatología del Hospital Infantil Norte Docente "Juan De La Cruz Martínez Maceira" de Santiago de Cuba en el periodo enero-diciembre de 2013. El universo lo constituyeron 754 pacientes egresados del servicio, sus madres acompañantes y 40 enfermeras que se encontraban laborando en el servicio. Se confeccionaron indicadores de calidad con estándares establecidos para estructura, proceso y resultado, se aplicó un instrumento evaluativo a las enfermeras y encuesta de satisfacción a las madres de los neonatos. Resultados: el indicador estructura alcanzó estándares no aceptables en cuanto a equipamiento no apto para su uso y la estructura del servicio, en el proceso y resultados todos sus indicadores fueron evaluados de aceptables, existiendo buen grado de satisfacción de la totalidad de las madres que acudieron con sus bebitos. Conclusión: no se detectaron dificultades en los indicadores de proceso y resultados evidenciando que existe calidad de la atención de enfermería en el servicio de neonatología(AU)

ABSTRACT Introduction: You define Pediatría's American Academy as intensive care those that you receive the gravely sick newborn baby or the ones that call for a close watch of the professionals of the neo-natal unit. The quality of the sanitary attention is an attribute more and more appraised for all the implicated in the attention to health (professionals, users and managers) although each one of these groups emphasizes some aspects in particular with respect to the rest. Objective: Evaluating the quality of Enfermería's attention in Neonatología's Service. Methods: Juan De accomplished a Descriptive, prospective and longitudinal study himself, in Neonatología's Service of the Infantile North Teaching Hospital James's Cross Martínez Maceira of Cuba in the period January December 2013. The universe was constituted by 754 patients left of the service, his accompanying mothers and 40 nurses that were meeting laboring in the service. They manufactured indicators of quality with standards established for structure, process and result, evaluativo applied over itself an instrument to the nurses and polls of satisfaction the mothers of the neo-born. Results: The indicator structure caught up with standards not acceptable as to unsuited equipamiento for his use and the structure of the service, in the process and once all his indicators were proven to be they were evaluated of acceptable, existing good grade of satisfaction of the totality of the mothers that attended with his little babies. Conclusion: They did not detect difficulties in the indicators of process and results evidencing that quality of the attention of infirmary in neonatología's service exists(AU)

Un modelo estructural de motivación intrínseca / A structural model of intrinsic motivation

Resumen El propósito principal de la presente investigación fue elaborar y probar un modelo estructural de la motivación intrínseca entre estudiantes de la Universidad de Sonora hacia los currículos de sus respectivas carreras. Un objetivo secundario fue superar las limitaciones del modelo de motivación intrínseca elaborado entre estudiantes de la UNAM. Se emplearon 8 escalas psicométricas desarrolladas por los autores en estudios previos, las cuales presentaron valores satisfactorios de confiabilidad y validez. El modelo sometido a prueba fue similar al de la muestra de la UNAM, excepto por la ausencia de las variables percepción escolar y valor, las cuales presentaron correlaciones bajas no significativas con la mayoría de las variables. El ajuste del modelo fue satisfactorio como lo evidencian los valores de diversos índices. La proporción de varianza explicada de la motivación intrínseca fue relativamente alta (0.498). Las 3 variables con los efectos directos más grandes sobre dicha motivación fueron autoeficacia, orientación al logro y certeza en la elección de carrera. La morosidad, tan común en los salones de clase, afecta negativamente a la autoeficacia, a la orientación al logro y a la motivación intrínseca, y a su vez, es reforzada por la evitación al trabajo y el temor al fracaso.

Abstract The main purpose of this research was to develop and test a structural model of intrinsic motivation among students of the University of Sonora to the curriculum of their careers. A secondary objective was to overcome the limitations of the model developed among students of the UNAM. Eight psychometric scales developed by the authors in previous studies were used, which showed satisfactory reliability and validity values. The model tested was similar to the sample of the UNAM, except for the absence of school perception and value variables, which showed no significant low correlations with most of the variables. The model fit was satisfactory as suggested by the values of various indexes. The proportion of variance explained by intrinsic motivation was relatively high (0.498). The 3 variables with the greatest direct impact on intrinsic motivation were self-efficacy, achievement orientation and certainty in career choice. Procrastination, so common in classrooms, negatively affects the self-efficacy, the achievement orientation and intrinsic motivation, and in turn, is reinforced by the work avoidance and fear of failure.

Precision liver surgery / 中华消化外科杂志

Continnous theoretical and technological progress in the face of increasing expectations for quality of health care and progress in medical technology has transformed the surgical paradigm.Based on the historical trends and technique advances,a novel paradigm ofPrecision Surgery has been proposed,which is featuring certainty-based practice to ensure the best results for each patient with multi-objective optimization of therapeutic effectiveness,surgical safety and minimal invasiveness.The main characteristics of precision surgery may be summarized as determinacy,predictability,controllability,integration,standardization and individualization.The strategy of precision hepatic surgery is to seek a balance of maximizing the removal of the target lesions,while maximizing the functional remnant liver and minimizing surgical invasiveness.The concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery.

La certeza y el aseguramiento del inconsciente / Certainty and assurance of the unconscious

Este artículo se propone trabajar en torno a las operaciones clínicas que posibilitan que el síntoma sea incluido dentro del dispositivo analítico para ser tratado. A partir de viñetas clínicas nos proponemos realizar algunas precisiones acerca del rol operatorio que tiene una variante metodológica de la certeza en el dispositivo analítico. Dicha certeza se ubica en función de la resistencia a la asociación libre y redunda en la constitución del inconsciente en tanto escenario psíquico determinante en la causación de los síntomas. Así mismo, precisa el modo en que, vía la repetición en el curso del tratamiento, el trabajo del análisis se acompasa con lo real del padecimiento y logra incidir sobre el mismo.

This article aims to work around clinical operations that enable a symptom to be included in the analytical treatment. From clinical vignettes we intend to provide some details about the role that has a variant of methodological certainty in analytical treatment. Such certainty is located based on the resistance to free association and leads to the constitution of the unconscious revealing its role in the determination of the symptoms. Likewise, the article intends to describe the way which, via the repetition during the treatment, the work of the analysis proves to be successful at treating a symptom.

Transitoriedade ou o desterro da certeza / Transitoriness or exile from certainty / La fugacité ou l'exil de la certitude / La transitoriedad o el destierro de la certeza

O tema da transitoriedade era lugar-comum da medicina da alma da primeira modernidade. Este artigo analisa algumas dessas fontes para mostrar como a dor do tempo e os males da alma atinentes eram relacionados a um modo de encarar a fugacidade do tempo e a fragilidade da vida. Dá-se destaque, sobretudo, às construções em torno da condição humana enquanto desterro da certeza.

The theme of transitoriness was commonplace in medicine of the soul of early modernity. This article examines some of these sources to show how the pain of time and similar ailments of the soul were related to a way of dealing with the fleetingness of time and the fragility of life. The author underlines constructions of the human condition as exile from certainty.

Le thème de la fugacité était un lieu commun de la médecine de l'âme de la première modernité. Cet article examine quelques-unes de ces sources pour montrer comment la douleur du temps et le maux de l'âme étaient liés à une façon d'envisager la nature éphémère du temps et la fragilité de la vie. Cet article met en relief les constructions liées à la condition humaine comprise comme exil de la certitude.

El tema de la transitoriedad era un lugar común en la medicina del alma durante la primera modernidad. Este artículo analiza algunas de esas fuentes para mostrar como el dolor del tiempo y los males del alma estaban relacionados a un modo de encarar la fugacidad del tiempo y la fragilidad de la vida. Se destaca sobretodo las construcciones en torno de la condición humana como destierro de la certeza.

Influencia en la certeza diagnóstica de los errores médicos en la discusión diagnóstica / Influence of medical errors in diagnostic discussion upon diagnostic certainty

El diagnóstico es un fin y un medio indispensable para establecer una terapéutica eficaz. Hay quienes lo señalan como la parte más importante del trabajo médico, pero existen dificultades en la forma de enseñarlo. Objetivo: establecer la relación entre los errores en la discusión diagnóstica y la certeza diagnóstica. Métodos: se realizó un estudio descriptivo basado en el análisis de 75 discusiones diagnósticas escritas y expuestas por 36 médicos de la especialidad de Medicina Interna del Hospital Militar Central "Dr. Carlos J. Finlay". Cada discusión fue analizada a través de una guía de observación, de forma individual por tres profesores, los cuales discutían lo observado para definir los errores cometidos durante discusión diagnóstica. Resultados: los errores más frecuentes fueron: no abordar la afectación ni el padecer, no pronostica, error diagnóstico etiológico y entidad nosológica errada; los dos últimos con diferencias estadísticamente significativas. Conclusiones: existen limitaciones conceptuales de lo que incluye el diagnóstico como resultados. La mayor parte de los errores no se asocia de forma significativa con la certeza diagnóstica...

Diagnosis is both an end and an indispensable means to establish an effective treatment. To some it is the most important part of medical practice. However, there are difficulties related to the way it should be taught. Objective: determine the relationship between errors in diagnostic discussion and diagnostic certainty. Methods: a descriptive study was conducted based on the analysis of 75 diagnostic discussions written and presented by 36 internal medicine specialists from Dr. Carlos J. Finlay Central Military Hospital. All discussions were analyzed by three professors based on an observation guide. The three professors would then discuss their observations with a view to defining the errors made during diagnostic discussion. Results: the most common errors were the following: not dealing with the disorder or condition, not making a prognosis, wrong etiological diagnosis and wrong nosological entity, the latter two with statistically significant differences. Conclusions: there exist conceptual limitations as to what to include in the diagnosis as results. Most errors are not significantly associated with diagnostic certainty.

Relación de la certeza diagnóstica con los errores en estudios complementarios / Relation between diagnostic certainty and errors in complementary studies

Introducción: con el desarrollo impetuoso de la tecnología, se ha producido una situación en que no pocos médicos y pacientes, han perdido la confianza en el interrogatorio, el examen físico y el razonamiento médico, y sobrevaloran el uso de la tecnología en el diagnóstico. No es raro, tampoco, encontrarse con el caso de que a una pequeña anormalidad en un examen complementario, se le ofrezca más valor que al cuadro clínico del paciente. Objetivo: determinar la relación entre los errores en estudios complementarios y la certeza diagnóstica. Métodos: se realizó un estudio descriptivo, basado en la observación de la indicación de estudios complementarios por 36 médicos de la especialidad de Medicina Interna. Resultados: los tres errores más frecuentemente observados en los exámenes complementarios fueron: utilización de rutinas, estudios innecesarios y no informar al enfermo de los resultados. Las diferencias observadas entre los grupos según certeza diagnóstica, no resultaron estadísticamente significativas. Conclusiones: los errores más frecuentes en la utilización de los exámenes complementarios, muestran un mal razonamiento clínico previo a su indicación. Ningún error identificado se asoció de manera significativa a la certeza del diagnóstico. La indicación y evaluación de los estudios complementarios debe hacerse vinculada a la del razonamiento diagnóstico, así se evita la indicación de rutinas y estudios innecesarios

Introduction: with the impetuous development of technology, a situation has arisen in which a considerable number of physicians and patients have lost their confidence in clinical interviews, physical examination and clinical reasoning, and overestimate the use of medical technology for diagnostic purposes. It is not uncommon that a small abnormality found in a complementary test is given more importance than the patient's clinical status. Objective: determine the relation between errors in complementary studies and diagnostic certainty. Methods: a descriptive study was conducted based on the indication of complementary studies by 36 internal medicine specialists. Results: the three most common errors found in complementary examinations were the use of routines, unnecessary studies and not informing results to the patient. The differences found between the groups as to diagnostic certainty were not statistically significant. Conclusions: the most common errors in the use of complementary examinations are evidence of faulty clinical reasoning before their indication. None of the errors identified was significantly associated with diagnostic certainty. Indication and evaluation of complementary studies should be linked to diagnostic reasoning, to prevent the indication of routines and unnecessary studies

Os atos do sujeito e a certeza: algumas considerações sobre a clínica psicanalítica na urgência / The acts of subject and certainty: some considerations on the psychoanalytic clinic in the urgency / Les actes du sujet et la certitude: quelques réflexions sur la clinique psychanalytique dans l'urgence

O artigo pretende correlacionar a questão da certeza com a clínica da urgência subjetiva. Valemo-nos dos esquemas sobre alienação e separação elaborados por Lacan em seu seminário sobre o Ato Analítico. Este percurso nos orienta quanto à importância do objeto a como organizador da clínica, uma vez que é diante da presença deste objeto que o sujeito responde através dos atos, resposta que revela a obtenção de uma falsa certeza por meio da alienação. Através do ato analítico o que se tem é a possibilidade da extração de uma certeza por meio do trabalho de transferência, a ser manejada de acordo com a temporalidade inerente a cada ato. A consideração de tais aspectos favorecerá a elaboração de estratégias de abordagem que levem em conta tanto a estrutura subjetiva quanto a apresentação do sujeito a partir dos atos, como poderá ser verificado na exposição de um fragmento de caso clínico

The article intends to correlate the issue of certainty with the clinic of subjective urgency. We have used the diagrams of alienation and separation developed by Lacan in his seminar about the Psychoanalytic Act. This course guide us to the importance of the object a as an organizer of the clinic, it is due to the presence of that the subject answers through the acts, revealing a false assurance by means of alienation. Through the psychoanalytic act we have the possibility of extracting a certainty by means of transference work, to be handled in according to the temporality or each act. The consideration of such appearances will favor the development of strategies to approach that takes into account both the subjective structure and presentation of the subject since the acts, as can be seen in the exhibition of a fragment of a clinical case

Cet article vise à corréler la certitude avec la clinique de la urgence subjective. Nous avons utilisé les formes d'aliénation et de séparation développées par Lacan dans son séminaire sur l'Acte Analytique. Ce parcours nous conduit sur l'importance de l'objet en tant qu'organisateur de la clinique, car il est dans la présence de cet objet que le sujet répondre par les actes, ce qui révèle la obtention d'une assurance fausse au moyen de l'aliénation. À travers l'acte analytique est ce qui a la possibilité d'extraire une certitude par des moyens de travail de transfert qui doivent être gérées conformément à la temporalité inhérente à tout acte. La prise en compte de ces facteurs favorisent le développement de stratégies à l'approche qui tienne compte à la fois la structure subjective et la présentation de l'objet à partir des actes, comme on peut le voir dans l'exposition d'un fragment d'un cas clinique

Study on Interpretation of Quantitative Results of Prostate-specific Antigen Using Information Theory / 대한진단검사의학회지

BACKGROUND: The prostate-specific antigen (PSA) is considered the most useful among tumor markers currently used. However, its quantitative results are interpreted only qualitatively for the diagnosis of prostate cancer. The recently introduced information theory enables the information of the quantitative results transformed into Shannon's entropy (S) that represents uncertainties and then "1-S" representing diagnostic certainty. METHODS: The 882 urological patients enrolled were categorized into 2 groups: a patient group comprising 233 patients with prostate cancer and a disease control group comprising 649 patients with benign prostate disease. The level of PSA in all the patients was tested and was found to be > or =2 ng/mL. The variables like PSA level and age were modeled on logistic regression analysis to predict the probability of prostate cancer and the diagnostic certainty. RESULTS: The mean (SD) of PSA levels in the patient group and the disease control group were 44.5 ng/mL (37.62 ng/mL) and 5.7 ng/mL (3.70 ng/mL), respectively. The logistic regression model fitted well when the age variable was dichotomized at the age of 55 yr. The diagnostic certainty was lowest at a PSA level of 18.90 ng/mL in the 55-yr age group. CONCLUSIONS: The diagnostic certainty (1-S) of whether to diagnose prostate cancer or not at a certain PSA level could be obtained using the information theory. The methodology used in this study may help interpret the results of other quantitative tests.

Certeza e crenças delirantes / Certainty and delusional beliefs

O presente artigo examina a abordagem da certeza e das crenças delirantes na filosofia e na Psicanálise. Argumenta que, enquanto Wittgenstein proporciona uma compreensão de conceitos psicopatológicos como as crenças delirantes e suas relações com os julgamentos de racionalidade, Lacan, na Psicanálise, parece sugerir que é a certeza subjetiva o que conota certas crenças como delirantes. Propõe, nessa direção, que o argumento apresentado por Lacan coloca em questão a sugestão de Wittgenstein de que a crença delirante seria constituída por uma falha da racionalidade.

This article examines the approach to certainty and delusional beliefs in philosophy and psychoanalysis. It suggests that whereas Wittgenstein provides an understanding of psychopathological concepts such as delusional beliefs and its relationship to judgements of rationality, Lacan, in psychoanalysis seems to suggest that it is subjective certainty what marks out beliefs as delusional. In this sense, the present article proposes that Lacan’s account questions Wittgenstein’s suggestion that delusional beliefs would be constituted by a failure in rationality.