Inteligencia Artificial en Medicina y Salud: revisión y clasificación de las aplicaciones actuales y del futuro cercano y su impacto ético y social

This paper provides an overview of the current and near-future applications of Artificial Intelligence (AI) in Medicine and Health Care and presents a classification according to their ethical and societal aspects, potential benefits and pitfalls, and issues that can be considered controversial and are not deeply discussed in the literature. This work is based on an analysis of the state of the art of research and technology, including existing software, personal monitoring devices, genetic tests and editing tools, personalized digital models, online platforms, augmented reality devices, and surgical and companion robotics. Motivated by our review, we present and describe the notion of “extended personalized medicine”, we then review existing applications of AI in medicine and healthcare and explore the public perception of medical AI systems, and how they show, simultaneously, extraordinary opportunities and drawbacks that even question fundamental medical concepts. Many of these topics coincide with urgent priorities recently defined by the World Health Organization for the coming decade. In addition, we study the transformations of the roles of doctors and patients in an age of ubiquitous information, identify the risk of a division of Medicine into “fake-based”, “patient-generated”, and “scientifically tailored”, and draw the attention of some aspects that need further thorough analysis and public debate

Analgesia epidural para el trabajo de parto en gestante con esclerosis múltiple

La Esclerosis Múltiple (EM), es una enfermedad del SNC siendo 2 veces más frecuente su aparición en mujeres, el 70% de ellas en edad fértil. Desde el punto de vista anestésico nos encontramos ante una enfermedad con elevada susceptibilidad neurológica que podría agravarse tanto por la propia cirugía, la técnica anestésica como por la medicación utilizada. Por otra parte se plantea como atender la demanda de analgesia para el trabajo de parto en mujeres con EM, que es el grupo de edad con mayor incidencia de la enfermedad. Presentamos el caso de una mujer de 37 años diagnosticada de esclerosis múltiples 3 años antes, forma recidivante, remitente. La paciente es ingresada en dilatación con 37 semanas de amenorrea, presentando una buena evolución del trabajo de parto y encontrándose el feto en situación longitudinal y presentación cefálica. Avisan al Servicio de Anestesia para valoración de la indicación de epidural para analgesia del parto. La gestante previamente había acudido a consulta de preanestesia donde se le había informado del riesgo beneficio de la técnica y en concreto en su caso, habiendo entendido perfectamente las posibles complicaciones derivadas de la misma y firmado el consentimiento informado. Nosotros hemos preferido utilizar una técnica locoregional, vía epidural considerando también el riesgo potencial de cesárea urgente, para evitar, dado el caso la realización de una técnica intraraquídea o una anestesia general, con las posibilidades de desencadenar un brote que tienen estas técnicas. Además de aportar confort a la paciente durante el trabajo de parto, proporcionar analgesia durante el mismo, disminuye por este motivo el estrés de la gestante pudiendo paralelamente evitar la aparición de un brote.Multiple sclerosis (MS) is a disease of the central nervous system (CNS), and twice as prevalent in women, 70% of whom are of fertile age. From an anaesthetics point of view, due to it being a disease with a high neurological susceptibility it can be aggravated by, the surgery itself, the anaesthetic technique and the medication used. On the other hand, it is about how to meet the demand for analgesia during labour by women with MS, which is the age group with a higher incidence of the disease. We present the case of a 37 year-old woman who was diagnosed 3 years before with a remitting, recurring Multiple Sclerosis. The patient was admitted in dilation in the 37th week of gestation. Labour was progressing well and the foetus was in a longitudinal lie and cephalic presentation. The Anaesthesia Department was informed to assess the indication of an epidural for analgesia during labour. The patient had been seen previously in a pre-anaesthesia clinic were she was informed of the risks and benefits of the technique and in her case in particular. Having understood the possible complications arising from this, she had signed the informed consent. We prefer to use the local/regional epidural technique, bearing in mind the potential risk of an urgent caesarean. This is also to avoid, as is the cases when performing an intra-spinal technique or general anaesthesia, the possibilities of triggering a rash, which can occur with these techniques. Besides giving comfort to the patient during labour, it provides analgesia, and for this reason reduces stress in the patient, as well as being able to prevent a rash appearing

Multilayer optical strip for illumination, imaging and analysis

An optical device (multilayer optical strip, MOS) is presented. It is composed of a small-sized, strip-shaped, multilayer, planar structure connected to a control unit. Active and passive optical elements allow for controlling the properties, spatial structure and time sequences of the emitted and received light. Several strips can be interconnected for specific applications. The external unit provides electrical power, drains heat, receives data and images, and allows for additional connectivity. Depending on the structure and materials of the layers, the optical strip/s can be flexible, rigid or of variable shape. They can be attached to instruments and tools for use in difficult-to-reach conduits and cavities. The strip/s can be sheathed for specific environments and sterilization or be disposable. The device can be portable, powered on batteries, cost-effective and easy to manufacture. Main areas of application span from surgery, medicine, dentistry, biology and veterinary to optical sensing of pollutants and pathogens, industrial inspection and quality control. It is suitable for use in small spaces such as vehicles, in emergency or disaster areas and in low-resources or developing environments. Four cases of use are presented: deep-field surgical illumination, optical analysis of materials, inner imaging of cavities and optical control of devices

Impacto de un programa de educación sanitaria en pacientes con fibromialgia

Objectives: To assess the impact of a health education program on the quality of life and frequency of clinic visits on patients with fibromyalgia (FM). Material and method: A prospective clinical study on a volunteer cohort before a health intervention. Setting: Health Centre A Alcala de Guadaira, Seville, Spain, which covers a population of 75,000 inhabitants. The population group was based on the number of patients diagnosed with FM by a rheumatologist or area resident according to the criteria of the American College of Rheumatology of 1990, who attended our clinic due to their disease in the last year, excluding those who suffered severe rheumatic diseases. A clinical assessment protocol was completed. The Fibromyalgia Impact Questionnaire, Spanish version (SFIQ) was used to assess the quality of life, the Medical Outcomes Study for the perception of social support, and for the evaluation of anxiety-depression symptoms, the Goldberg Anxiety-depression Scale (GADS) was used. Demographic data, occupational aspects, type of sensation, number of clinic visits in the past year for this reason, concomitant illnesses, and type and number of drugs taken. After collecting the data, the sample was randomly distributed into intervention groups. The participants were divided into 6 groups of 12, and they attended four 1-hour sessions of health education per month, at weekly intervals. The sessions contained the following: a) general information on the disease; b) physical-rehabilitation/physical exercise measures and postural hygiene, and c) relaxation techniques (the E. Jacobson technique was used). After one month of intervention, the SFIQ was completed again by all the study participants. The anxiety-depression symptoms were also measured according to GADS. We recorded the frequency of visits for one year after the intervention. Results: There were 114 patients diagnosed with FM in our health centre; all were women with a mean age of 43.05 years, with 70% being housewives who did not drink or smoke. A total of 86.8% regularly took anti-inflammatory drugs and/or analgesics, 74.6% antidepressants and 77% tranquillisers, with 25% taking 3 or more drugs simultaneously. The great majority, 89% did not do any regular exercise. The main symptoms referred to were, neck pain, back pain and sleep disorders in 86%. Depression was the most common comorbidity found (86%), followed by anxiety (82%), high blood pressure (64%), and diabetes mellitus (43%). The mean S-FIQ score was 52.51. Half of them had a good social support network, with 3 patients totally lacking support. The mean frequency of visits was 18.35 per year. After the intervention, we found a decrease in the S-FIQ score (P<0.05) and a reduction of up to 60% in the number of clinic visits for this reason (P<0.005). There was a notable improvement in the anxiety and depression symptoms (P<0.005). Conclusions: Health education for patients with FM, changes their quality of life perception, increases their knowledge of their disease, thus decreasing their dependency on health services. There is also tendency to decrease anxiety and depression symptoms.Objetivos: Valorar el impacto de un programa de educación sanitaria sobre la calidad de vida y sobre la frecuentación a consulta de personas con fibromialgia (FM). Material y método: Evaluación clínica prospectiva de una cohorte de voluntarios ante una intervención en salud. Emplazamiento: Centro de Salud Alcalá de Guadaira A, con una cobertura poblacional de 75.000 habitantes. Se constituyó el grupo poblacional sobre la base del número de pacientes diagnosticadas de FM por el reumatólogo o el internista de la zona, según los criterios del American College of Rheumatology de 1990 que consultaron en nuestro centro a causa de su enfermedad en el último año, excluyendo aquellas que padecieran enfermedades reumatológicas graves. Se cumplimentó un protocolo de valoración clínica; para la evaluación de la calidad de vida se utilizó el Fibromyalgia Impact Questionnarie, versión española (SFIQ). Para la percepción de apoyo social (Medical Outscome Study) y para la valoración de síntomas ansiosos depresivos se utilizó la escala de ansiedad y depresión de Golberg. Se registraron datos demográficos, aspectos laborales, tipo de sensación, número de visitas en el último año a consulta por este motivo, patología coadyuvante, y tipo y número de fármacos consumidos. Posteriormente a la recogida de datos se distribuyó la muestra aleatoriamente en grupos de intervención; se le realizaron, durante 6 meses, cuatro sesiones/mes de educación sanitaria de una hora de duración cada una y en intervalos de una semana. Para ello se dividió a las participantes en 6 grupos de 12. El contenido de las sesiones fue el siguiente: a) información general de la enfermedad; b) medidas fisicorrehabilitadoras/ejercicio físico e higiene postural, y c) técnicas de relajación (se utilizó la técnica de Jacobson). Al mes de la intervención se volvió a administrar el SFIQ a todas las participantes del estudio. También medimos síntomas de ansiedad/depresión según la escala de ansiedad y depresión de Golberg. Recogimos la frecuentación durante un año después de la intervención. Resultados: En nuestro centro de salud estaban diagnosticadas de FM 114 pacientes; todas mujeres, con una media de edad de 43,05 años. Las pacientes eran amas de casa en un 70% y no tenían hábitos tóxicos. Un 86,8% tomaba antiinflamatorios y/o analgésicos de forma habitual, el 74,6% tomaba antidepresivos, el 77% tomaba ansiolíticos y un 25% tomaba 3 o más fármacos de forma simultánea. En su mayoría, el 89% no realizaba ejercicio de forma habitual. Los principales síntomas referidos fueron cervicalgia, dolor de espalda y trastornos del sueño en un 86%. La depresión fue la comorbilidad más frecuentemente encontrada (86%), seguida de la ansiedad (82%), la hipertensión arterial (64%) y la diabetes mellitus (43%). La puntuación media del SFIQ fue de 52,51. La mitad de ellas contaba con una buena red de apoyo social, careciendo totalmente de ella 3 pacientes. La media de frecuentación era de 18,53 visitas/año. Tras la intervención, encontramos una disminución en el puntaje del SFIQ (p<0,005) y una reducción de hasta un 60% del número de visitas médicas por este motivo (p<0,005). Hubo una notable mejoría en cuanto a los síntomas ansiosos y depresivos (p<0,005). Conclusiones: La educación sanitaria en pacientes con FM modifica su percepción de calidad de vida. Aumenta su conocimiento sobre la enfermedad, disminuyendo su dependencia de los servicios sanitarios. Existe además una tendencia a disminuir los niveles de ansiedad y depresión