Difference between revisions of "Conclusioni sullo status quo nella logica del linguaggio medico riguardo al sistema masticatorio"

The model presented here above, of course, is remarkably complex because in this context only the conceptual procedure to follow has been presented: we will see later in the course of reading that everything will materialize in interesting modeling of the trigeminal electrophysiological responses from which a clinical mesoscopic model will be created, of which we can already anticipate the name: '''Index <math>\Psi</math>'''.  

== Introduction ==

After a lexical path concerning the status quo in the field of diagnostics of the masticatory system, sometimes apparently off topic, we have reached the stage in which all the discourses crystallize in clinical practice and therefore we will try to explain the reason for so much dialectical length.  

First of all, we can defend this strategy of conceptual exposure with the difficulty of the change of mindset which is generally innate in the human being, like Kuhn explains so clearly in his scientific philosophy of 'Paradigms'. He taught us that the new paradigms, namely the 'Extraordinary Science', generate tenacious opponents to their acceptance. This is also justifiable, because there are a myriad of storytellers around, although it is also true that the new paradigms destabilize the acquired power and that is why they are often rejected even by confirmed cultural environments.

Having said that, however, the fact is that here there is a human being called 'Patient' involved, and the restriction of the cultural and progressive field does not go to the detriment of the man of power (a professor, a politician, ...) but exclusively of the patient. Since the project follows the Feyerabend philosophy, as already said in previous pages, Masticationpedia shows all its loyal, democratic and ethical scientific thinking with ideas, facts and clinical cases, the rest will be time to judge the veracity of the project.

==Errors and causes==

Medical errors diagnose as much as the axioms on which therapeutic models are based are continually clashing between titans of the clinical scientific scene as some studies on the subject point out:

* The lack of standardized nomenclature and overlapping definitions of medical errors has hindered the analysis, the synthesis and data evaluation.<ref>{{cita libro  

* The diagnostic process is collaborative and involves the patient, the clinician, the healthcare system and its various stakeholders <ref>

* Contributing factors associated with misdiagnosis included dentist knowledge and skills, inadequate time, lack of communication between colleagues, and cognitive biases such as premature closure based on prior experience. Some participants perceived that an error only occurs when the choice of treatment leads to harm. The strategies suggested by the participants to prevent these errors required adequate time to investigate a case, form study groups, increase communication, and place greater emphasis on differential diagnosis.<ref>{{cita libro  

These three bibliographic references were enough to extrapolate some essential concepts such as:  

*'''standardized nomenclature''', which presupposes the need for formal methodologies, like in mathematical and physical sciences, and not subjective and/or exclusively descriptive models.  

*the '''diagnostic process''' understood as an 'Observable' in which several elements are involved, such as the observer, the measuring instrument, the patient as well as the ability to interpret verbal language and decode the encrypted signal of the observed system;  

*place greater emphasis on '''differential diagnosis''', a key element that we will try to demonstrate practically with some cases mentioned in the previous chapters.

==A coherent language==

These quotations and questions have led us to a more appropriate and profound description of the topics covered in the previous chapters, because we cannot talk about standardized nomenclature, diagnostic process and differential diagnosis without talking about:

* '''Epistemology of knowledge'''

Epistemology (from the Greek ἐπιστήμη, epistème, "certain knowledge" or "science", and λόγος, logos, "discourse") is that branch of philosophy that deals with the conditions under which scientific knowledge can be obtained and the methods to achieve such knowledge. The term specifically indicates that part of gnoseology that studies the foundations, validity and limits of scientific knowledge.

In fact, an almost unlimited value has been given to a statistical test such as <math>P-value</math> <ref>{{cita libro  

  }}</ref> and to the statistical data of a 'Classical Probability' based on Bayes' Theorem (which we will discuss in the next chapters)<ref>{{cita libro  

  }}</ref> and then witness a relative brake on the subject <math>P-value</math> <ref>{{cita libro  

  }}</ref> and all that is <nowiki>'</nowiki>'''Epistomology'''<nowiki>'</nowiki>, that almost spontaneously highlighted another fundamental passage that of 'Interdisciplinarity', a phenomenon that only with great effort is recognized as important as the specialized disciplines.

* '''Interdisciplinarity'''

The proposed alternative philosophical paradigm, called the "Engineering Paradigm of Science" implies alternative philosophical assumptions regarding aspects such as the purpose of science, the character of knowledge, the epistemic and pragmatic criteria for the acceptance of knowledge and the role of technological tools. Consequently, scientific researchers need so-called metacognitive scaffolds to aid in the analysis and reconstruction of how "knowledge" is constructed in different disciplines. <ref>Boon M, Van Baalen S, «'''Epistemology for interdisciplinary research - shifting philosophical paradigms of science'''», in [[:Category:Citations from Eur J Philos Sci|Eur J Philos Sci]], 2019. <small>DOI:10.1007/s13194-018-0242-4</small> </ref><ref>Boon M, «'''An engineering paradigm in the biomedical sciences: Knowledge as epistemic tool'''», in [[:Category:Citations from Prog Biophys Mol Biol|Prog Biophys Mol Biol]], 2017.<small>DOI:10.1016/j.pbiomolbio.2017.04.001</small> </ref> Precisely these 'Metacognitive Scaffolds' have allowed us to consider an important requirement in diagnostics that of 'basic knowledge' which tends to reduce the vagueness and ambiguity of the logic of medical language.<ref>Codish S, Shiffman RN, «'''A model of ambiguity and vagueness in clinical practice guideline recommendations'''», in [[:Category:Citations from AMIA Annu Symp Proc|AMIA Annu Symp Proc]], 2005.<small>PMID:16779019</small></ref>

* '''Logic of medical language'''

These premises <ref>Boon M, Van Baalen S, «'''Epistemology for interdisciplinary research - shifting philosophical paradigms of science'''», in [[:Category:Citations from Eur J Philos Sci|Eur J Philos Sci]], 2019<small>DOI:10.1007/s13194-018-0242-4</small> </ref> <ref>Boon M, «'''An engineering paradigm in the biomedical sciences: Knowledge as epistemic tool'''», in [[:Category:Citations from Prog Biophys Mol Biol|Prog Biophys Mol Biol]], 2017<small>DOI:10.1016/j.pbiomolbio.2017.04.001</small></ref> led us to the description of 'Fuzzy logic' models in which the 'Basic knowledge' is stratified at multiple levels of the context in multiple disciplines, increasing its capacity in differential diagnosis. All this is '''Logic of medical language'''<nowiki/>' with which we followed the diagnostic process of our poor patient 'Mary Poppins' who for 10 years hoped to be made a certain diagnosis despite the various attempts of clinical scientific propositions in the dental and neurological context:

<math>\delta_2=</math> Positive CT report of the TMJ in Figure 3

<math>\delta_3=</math> Positive axiographic report of the condylar traces in Figure 4

<math>\delta_4=</math>  Asymmetric EMG interference pattern in Figure 5

'''Propositions in the Neurological Context'''

<math>{\displaystyle \gamma _{2}}=</math> Mechanical Silent Period in Figure 7

<math>{\displaystyle \gamma _{3}}=</math>  CT right masseter muscle in Figure 8<center>

===Propositions in the Dental Context===

File:Spasmo emimasticatorio.jpg|'''Figure 1:'''  Patient in '''entry''' in the Functional Neuro Gnathology Department who reported right hemilateral orofacial pain for 10 years with previous diagnosis of Temporomandibular Dysfunction.

File:Spasmo emimasticatorio ATM.jpg|'''Figure 2:'''  <math>\delta_1=</math> Patient's TMJ Stratigraphy showing signs of condylar flattening and osteophyte

File:1600px-Spasmo emimasticatorio assiografia.jpeg|''' Figure 4:''' <math>\delta_1=</math> Axiography of the patient showing a flattening of the chewing pattern on the right condyle

File:EMG2.jpg|'''Figure 5:''' <math>\delta_2=</math> EMG Interferential Pattern. Overlapping upper traces corresponding to the right masseter, lower to the left masseter.  

'''Propositions in the Neurological Context'''<gallery widths="350" heights="200" perrow="4" slideshow""="">

File:Spasmo emimasticatorio JJ.jpg|'''Figure 6:''' <math>{\gamma _{1}}=</math> Jaw jerk electrophysiologically detected on the right (upper traces) and left (lower traces) masseters

File:Spasmo emimasticatorio SP.jpg|'''Figure 7:''' <math>\gamma _2=</math> Mechanical silent period detected electrophysiologically on the right (upper overlapping traces) and left (lower overlapping traces) masseters

File:Spasmo emimasticatorio TC.jpg|''' Figure 8:''' <math>\gamma _3=</math> CT shows evident hypertrophy of the right masseter

File:Spasmo emimasticatorio.jpg|'''Figura 9:''' Patient in '''leaving''' from the Functional Neuro Gnathology Department after 1 week with differential diagnosis of 'Hemimasticatory Spasm'