Creado apartir del commit b888de6c92056de294456f581a56e25e734d4ab7 de develop
This commit is contained in:
jrojas
@@ -0,0 +1,695 @@
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using adas_core.Application.Services.Interfaces;
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using adas_core.Domain.Enums;
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using adas_core.Domain.Models;
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using adas_core.Domain.Models.AppSettings;
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using adas_core.Domain.Models.Pumps;
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using Microsoft.Extensions.DependencyInjection;
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using Microsoft.Extensions.Logging;
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using Microsoft.Extensions.Options;
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using MongoDB.Bson;
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using MongoDB.Driver;
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namespace adas_core.Application.Customizations.HUVH.UCIA;
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public class CalculatedObservations : ICalculatedObservations
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{
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private const string CodingSystem = "ADAS";
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private readonly List<string>? _antibioticList;
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private readonly List<string>? _antidepressantsList;
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private readonly List<string>? _antihypertensivesList;
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private readonly List<string>? _antipsicoticList;
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private readonly List<string>? _anxiolyticsList;
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private readonly List<string>? _inotropicMedicines;
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private readonly ILogger<CalculatedObservations> _logger;
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private readonly Lazy<IMedicineService> _medicineService;
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private readonly List<string>? _neuroMedicationList;
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private readonly Lazy<IObservationService> _observationService;
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private readonly List<string>? _sedationList;
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private readonly List<string>? _serumColloidList;
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private readonly List<string>? _serumCrystalloidList;
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private readonly Lazy<ITreatmentService> _treatmentService;
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public CalculatedObservations(IServiceProvider serviceProvider)
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{
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_treatmentService = serviceProvider.GetRequiredService<Lazy<ITreatmentService>>();
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_medicineService = serviceProvider.GetRequiredService<Lazy<IMedicineService>>();
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_observationService = serviceProvider.GetRequiredService<Lazy<IObservationService>>();
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_logger = serviceProvider.GetRequiredService<ILogger<CalculatedObservations>>();
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var apiSettings = serviceProvider.GetRequiredService<IOptions<ApiSettings>>(); //apiSettings;
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_sedationList = apiSettings.Value.Sedation;
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_inotropicMedicines = apiSettings.Value.InotropicMedicines;
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_antibioticList = apiSettings.Value.AntibioticList;
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_anxiolyticsList = apiSettings.Value.AnxiolyticList;
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_antipsicoticList = apiSettings.Value.AntipsicoticList;
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_antidepressantsList = apiSettings.Value.AntidepressantsList;
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_neuroMedicationList = apiSettings.Value.NeuroMedicationList;
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_serumCrystalloidList = apiSettings.Value.SerumCrystalloidList;
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_serumColloidList = apiSettings.Value.SerumColloidList;
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_antihypertensivesList = apiSettings.Value.AntihypertensivesList;
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}
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public Task CalculateActiveBolus(ObjectId patientId)
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{
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throw new NotImplementedException();
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}
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public async Task<T?> Map<T>(T obs, bool onlyByName = false) where T : BasePatientObservation
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{
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if (obs.Name is "PSI" or "RASS" or "TS") _ = CalculateOverSedation(obs);
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if (obs.Name is "Inspiratory_Pressure" or "Compliancia" or "Air_Flow") _ = CalculateVentilationMode(obs);
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if (obs.Name is "ECMO_Location" or "Location_Drainage_Cannula" or "Location_Return_Cannula")
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obs = (T)await CalculateEcmoLocation(obs);
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if (obs.Name is "EVN" or "ANI" or "ESCID") _ = CalculateOverAnalgesia(obs);
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if (obs.Name is "Pmeset" or "PEEP") _ = CalculateDrivingPressure(obs);
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if (obs.Name is "SpO2_FiO2_Ratio" or "FR") _ = CalculateRoxIndex(obs);
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if (obs.Name is "Diuresis") _ = CalculateDiuresis(obs);
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if (obs.Name is "Rehabilitation") obs = (T)await CalculateRehabilitationAlarm(obs);
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return obs;
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}
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public async Task<PatientTreatment> Map(PatientTreatment treatment)
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{
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var order = treatment.PlacerOrder?.EntityIdentifier; //aquí almacenamos el número de orden
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if (string.IsNullOrEmpty(order)) return treatment;
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//comprobamos el estado de los tratamientos anteriores
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var oldTreatments = await CheckExpiredPatientTreatments(treatment);
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treatment.OrderControl = oldTreatments.Any() ? OrderControlType.Xo : OrderControlType.Nw;
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if (treatment.EndTime != null)
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//el tratamiento ha expirado
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treatment.OrderControl = OrderControlType.Dc;
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await CheckTreatmentMedicines(treatment);
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return treatment;
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}
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public async Task<PumpObservation> Map(PumpObservation pumpObservation)
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{
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return await Task.FromResult(pumpObservation);
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}
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public Task CalculateMedicineObservation(List<Medicine> activeMedicines, ObjectId patientId)
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{
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//Esto viene del schedulerService para chequear los medicamentos activos
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CheckMedicationCategories(patientId, activeMedicines);
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return Task.CompletedTask;
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}
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public async Task<IEnumerable<PatientTreatment?>> GetActiveTreatmentsByPatient(ObjectId id)
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{
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var activeTreatments = await _treatmentService.Value.GetActiveTreatmentsByPatient(id);
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return activeTreatments;
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}
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public Task<PatientDiagnosis> Map(PatientDiagnosis diagnosis)
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{
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throw new NotImplementedException();
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}
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public async Task<PatientObservation?> FixTimeInconsistencyWithLast(PatientObservation newObservation)
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{
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if (string.IsNullOrEmpty(newObservation.Name))
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{
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_logger.LogError(
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"Error FixTimeInconsistencyWithLast. Observation name is null or empty. Observation: {newObservation}",
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newObservation);
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return newObservation;
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}
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var lastObservations = await _observationService.Value.FindLastObservations(newObservation.PatientId, 1,
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[newObservation.Name]);
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var lastObservation = lastObservations.FirstOrDefault();
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if (lastObservation != null && DateTime.Compare(
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new DateTime(lastObservation.Time.Year, lastObservation.Time.Month,
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lastObservation.Time.Day, lastObservation.Time.Hour,
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lastObservation.Time.Minute, lastObservation.Time.Second),
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new DateTime(newObservation.Time.Year, newObservation.Time.Month,
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newObservation.Time.Day, newObservation.Time.Hour,
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newObservation.Time.Minute, newObservation.Time.Second)
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) >= 0)
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newObservation.Time = lastObservation.Time.AddSeconds(1);
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return newObservation;
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}
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public Task<List<PatientObservation>> PreMapList(List<PatientObservation> listToInsert)
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{
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return Task.FromResult(listToInsert);
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}
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public Task<PatientObservation> MapSourceAlarm(PatientObservation obs, PatientObservationAlarm alarmToInsert)
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{
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return Task.FromResult(obs);
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}
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public Task SendAlarm(PatientObservation obs, string name, AlarmEnum.Name? code)
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{
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throw new NotImplementedException();
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}
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private async Task<BasePatientObservation> CalculateRehabilitationAlarm(BasePatientObservation obs)
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{
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//En rojo si el grado es de 0 a 2 incluidos, por más de 7 días
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if (obs is not PatientObservation pobs || !int.TryParse(pobs.Value.ToString(), out var pobsValue) ||
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pobsValue > 2) return obs;
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var result = await _observationService.Value.FindLastObservations(obs.PatientId, 6, ["Rehabilitation"]);
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var obsInAlert = result.Count(o =>
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int.TryParse(o.Value.ToString(), out var oValue) && oValue is >= 0 and <= 2);
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if (obsInAlert == 6) pobs.Status = StatusEnum.Type.Alert;
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return obs;
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}
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private async Task CalculateDiuresis(BasePatientObservation obs)
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{
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// Calculado como el sumatorio de la Diuresis de las últimas 6h
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// entre el último peso medido del paciente y entre 6. Medido en ml/kg/h
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// Valor = sum(Diuresis últimas 6 horas) / Weight / 6
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if (obs is not PatientObservation pobs)
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return;
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double weightValue = 0;
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var numValues = pobs.Name switch
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{
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"Diuresis" => 2, // Si la observación entrante es "Diuresis", necesitamos las 2 últimas para completar 6h.
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"Weight" => 3, // Si la observación entrante es "Weight", necesitamos las 3 últimas de "Diuresis".
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_ => 0
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};
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if (numValues == 0)
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return; // Si no es ni Diuresis ni Weight, no aplicamos cálculo.
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// Obtener las observaciones de diuresis necesarias
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var diuresisObservations =
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await _observationService.Value.FindLastObservations(pobs.PatientId, numValues, ["Diuresis"]);
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var diuresisValues = diuresisObservations
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.Select(o => double.TryParse(o.Value.ToString(), out var value) ? value : 0)
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.ToList();
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if (pobs.Name == "Diuresis")
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{
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// Si la observación entrante es Diuresis, la agregamos
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if (double.TryParse(pobs.Value.ToString(), out var currentDiuresis))
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diuresisValues.Insert(0, currentDiuresis);
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// Buscar el último peso registrado
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var weightObservations =
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await _observationService.Value.FindLastObservations(pobs.PatientId, 1, ["Weight"]);
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var weightObs = weightObservations.FirstOrDefault();
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if (weightObs != null && double.TryParse(weightObs.Value.ToString(), out var wObsValue))
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weightValue = wObsValue;
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}
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else if (pobs.Name == "Weight" && double.TryParse(pobs.Value.ToString(), out var wValue))
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{
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// Si la observación entrante es Weight, asignamos su valor directamente.
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weightValue = wValue;
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}
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// Validaciones antes de calcular
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if (diuresisValues.Count < 3)
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{
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_logger.LogWarning("Calculated Diuresis lacks sufficient values. Required: 3, Found: {count}",
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diuresisValues.Count);
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return;
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}
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if (weightValue <= 0)
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{
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_logger.LogWarning("Calculated Diuresis aborted due to invalid weight value: {weight}", weightValue);
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return;
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}
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// Cálculo del índice de diuresis
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var diuresisIndex = diuresisValues.Sum() / weightValue / 6;
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var diuresisObs = new PatientObservation
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{
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PatientId = pobs.PatientId,
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Time = DateTime.UtcNow,
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CodingSystem = CodingSystem,
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Name = "Calculated_Diuresis",
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Value = diuresisIndex
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};
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await _observationService.Value.InsertObservation(diuresisObs, mapObs: false);
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}
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private async Task CalculateRoxIndex(BasePatientObservation obs)
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{
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// Cálculo dividiendo el ratio SpO2/FiO2 entre la FR
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// Valor = (SpO2_FiO2_Ratio) / FR
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if (obs is not PatientObservation pobs)
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return;
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List<string>? requiredObservations = pobs.Name switch
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{
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"SpO2_FiO2_Ratio" => ["FR"], // Si la observación actual es SpO2_FiO2_Ratio, necesitamos FR
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"FR" => ["SpO2_FiO2_Ratio"], // Si la observación actual es FR, necesitamos SpO2_FiO2_Ratio
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_ => null
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};
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if (requiredObservations is null)
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return;
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var result = await _observationService.Value.FindLastObservations(pobs.PatientId, 1, requiredObservations);
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var targetObs = result.FirstOrDefault();
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if (targetObs == null || !double.TryParse(targetObs.Value.ToString(), out var targetValue))
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return;
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// Determinar los valores necesarios para el cálculo
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var spo2FiO2Ratio = pobs.Name == "SpO2_FiO2_Ratio"
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? double.TryParse(pobs.Value.ToString(), out var ratio) ? ratio : 0
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: targetValue;
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var fr = pobs.Name == "FR"
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? double.TryParse(pobs.Value.ToString(), out var frValue) ? frValue : 0
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: targetValue;
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if (fr == 0) // Evita división por cero
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return;
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var roxIndexObs = new PatientObservation
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{
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PatientId = pobs.PatientId,
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Time = DateTime.UtcNow,
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CodingSystem = CodingSystem,
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Name = "Rox_Index",
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Value = spo2FiO2Ratio / fr
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};
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await _observationService.Value.InsertObservation(roxIndexObs, mapObs: false);
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}
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private async Task CalculateDrivingPressure(BasePatientObservation obs)
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{
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//Diferencia entre la Pmeset y la PEEP
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//Calculo Valor = Pmeset - PEEP
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try
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{
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if (obs is not PatientObservation pobs)
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return;
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var targetObservation = pobs.Name switch
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{
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"Pmeset" => "PEEP",
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"PEEP" => "Pmeset",
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_ => null
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};
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if (targetObservation is null)
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return;
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var resultList =
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await _observationService.Value.FindLastObservations(obs.PatientId, 1, [targetObservation]);
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var targetObs = resultList.FirstOrDefault();
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if (targetObs == null || !int.TryParse(targetObs.Value.ToString(), out var targetValue))
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return;
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var peepValue = pobs.Name == "PEEP"
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? int.TryParse(pobs.Value.ToString(), out var peep) ? peep : 0
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: targetValue;
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var pmesetValue = pobs.Name == "Pmeset"
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? int.TryParse(pobs.Value.ToString(), out var pmeset) ? pmeset : 0
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: targetValue;
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var drivingPressureObs = new PatientObservation
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{
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PatientId = obs.PatientId,
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Time = DateTime.UtcNow,
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CodingSystem = CodingSystem,
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Name = "Driving_Pressure",
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Value = pmesetValue - peepValue
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};
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await _observationService.Value.InsertObservation(drivingPressureObs, mapObs: false);
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}
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catch (Exception e)
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{
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Console.WriteLine(e);
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throw;
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}
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}
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private async Task CalculateOverAnalgesia(BasePatientObservation? obs, ObjectId? patientId = null)
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{
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// Mandar observación 'SOBREANALGESIA'
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// 0 <= EVN <= 3 o ESCID = 3 o ANI > 70
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// y
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// Perfusiones de morfina, remifentanilo y fentanilo sostenidas > 24h.
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try
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{
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List<string> requiredObservations = ["EVN", "ESCID", "ANI"];
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// Si patientId es null, la información proviene de una observación.
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// Si tiene valor, proviene de un tratamiento.
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if (!patientId.HasValue)
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{
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if (obs is not PatientObservation pobs || !int.TryParse(pobs.Value.ToString(), out _))
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return;
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patientId = pobs.PatientId;
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}
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var observations =
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await _observationService.Value.FindLastObservations(patientId.Value, 1, requiredObservations);
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// Verificar si alguna observación cumple la condición
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var condition1 = observations.Any(observation =>
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int.TryParse(observation.Value.ToString(), out var obsValue) && observation.Name switch
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{
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"EVN" when obsValue is >= 0 and <= 3 => true,
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"ESCID" when obsValue == 3 => true,
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"ANI" when obsValue > 70 => true,
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_ => false
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});
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if (!condition1)
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return;
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// Verificar tratamientos activos y umbral de analgesia
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var treatments = await _treatmentService.Value.GetActiveTreatmentsByPatient(patientId.Value);
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var patientTreatments = treatments.ToList();
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if (!patientTreatments.Any()) return;
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var morfina =
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patientTreatments.FirstOrDefault(t => t != null && t.RequestedGiveCodes.Any(c => c.Text is "Morfina"));
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var remifentanilo = patientTreatments.FirstOrDefault(t =>
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t != null && t.RequestedGiveCodes.Any(c => c.Text is "Remifentanilo"));
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var fentanilo =
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patientTreatments.FirstOrDefault(t =>
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t != null && t.RequestedGiveCodes.Any(c => c.Text is "Fentanilo"));
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if (morfina != null && !ExceedsAnalgesiaThreshold(morfina) &&
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remifentanilo != null && !ExceedsAnalgesiaThreshold(remifentanilo) &&
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fentanilo != null && !ExceedsAnalgesiaThreshold(fentanilo))
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return;
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var overAnalgesiaObs = new PatientObservation
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{
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PatientId = patientId.Value,
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Time = DateTime.UtcNow,
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CodingSystem = CodingSystem,
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Name = "Over_Analgesia",
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Value = bool.TrueString
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};
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await _observationService.Value.InsertObservation(overAnalgesiaObs, mapObs: false);
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}
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catch (Exception ex)
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{
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_logger.LogError("Error calculating Over_Analgesia. Exception: {ex}", ex);
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throw;
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}
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}
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private Task<BasePatientObservation> CalculateEcmoLocation(BasePatientObservation obs)
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{
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//Las opciones pueden ser VV, VA o ECMO.
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//Cuando llegue VV se muestra VV.
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//Cuando llegue VA se muestra VA.
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//Cuando llegue los siguientes parámetros, se debe mostrar ECMO: ECCO2r, VVDL, VA+V, VVDL+V, VV+V, VVA
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if (obs is not PatientObservation pobs)
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return Task.FromResult(obs);
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var ecmoValues = new List<string> { "ECCO2r", "VVDL", "VA+V", "VVDL+V", "VV+V", "VVA" };
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var obsValue = pobs.Value.ToString();
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if (obsValue != null && ecmoValues.Contains(obsValue)) pobs.Value = "ECMO";
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||||
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return Task.FromResult(obs);
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}
|
||||
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||||
private async Task CalculateVentilationMode(BasePatientObservation obs)
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||||
{
|
||||
//- Si llega valor de PI pero NO COMPL, el tipo de ventilación es VMNI
|
||||
//- Si llega valor de PS pero no llega COMPL, el tipo de ventilación es VMNI
|
||||
//- Si llega COMPL, el tipo de ventilación es VMI
|
||||
//- Si llega Flujo, leer el tipo de ventilación de CCC(CNAF o CTAF)
|
||||
|
||||
var mode = string.Empty;
|
||||
|
||||
switch (obs.Name)
|
||||
{
|
||||
case "Inspiratory_Pressure":
|
||||
var complObs = await _observationService.Value.FindLastObservations(obs.PatientId, 1, ["Compliancia"]);
|
||||
if (!complObs.Any())
|
||||
mode = "VMNI";
|
||||
|
||||
break;
|
||||
case "Compliancia":
|
||||
mode = "VMI";
|
||||
break;
|
||||
case "Air_Flow":
|
||||
var cccVentMode =
|
||||
await _observationService.Value.FindByPatientIdAndCodingSystemAsync(obs.PatientId, "CCC",
|
||||
"Ventilation_Mode");
|
||||
|
||||
if (!await cccVentMode.AnyAsync())
|
||||
return;
|
||||
mode = cccVentMode.First().Value.ToString() ?? string.Empty;
|
||||
break;
|
||||
default:
|
||||
return;
|
||||
}
|
||||
|
||||
if (string.IsNullOrEmpty(mode)) return;
|
||||
|
||||
|
||||
var ventilationModeObservation = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = CodingSystem,
|
||||
Name = "Ventilation_Mode",
|
||||
Value = mode
|
||||
};
|
||||
|
||||
_ = _observationService.Value.InsertObservation(ventilationModeObservation, mapObs: false);
|
||||
}
|
||||
|
||||
private async Task CalculateOverSedation(BasePatientObservation? obs, ObjectId? patientId = null)
|
||||
{
|
||||
//Mandar observación 'SOBRESEDACIÓN'
|
||||
//cuando:
|
||||
//(RASS =-4 o RASS =-5) y
|
||||
//PSI < 25 y
|
||||
//TS > 5 y
|
||||
//(Propofol > 3 o Midazolam > 0,05 ó Isoflorano > 10)
|
||||
|
||||
try
|
||||
{
|
||||
var pobsName = string.Empty;
|
||||
|
||||
//si patientId viene null viene la observación
|
||||
//Si tiene valor viene de un tratamiento
|
||||
|
||||
if (!patientId.HasValue)
|
||||
{
|
||||
if (obs is not PatientObservation pobs || !int.TryParse(pobs.Value.ToString(), out var pobsValue))
|
||||
return;
|
||||
|
||||
patientId = pobs.PatientId;
|
||||
pobsName = pobs.Name;
|
||||
|
||||
switch (pobsName)
|
||||
{
|
||||
case "RASS" when pobsValue is not (-4 or -5):
|
||||
case "PSI" when pobsValue >= 25:
|
||||
case "TS" when pobsValue <= 5:
|
||||
return;
|
||||
}
|
||||
}
|
||||
|
||||
|
||||
var requiredObservations = pobsName switch
|
||||
{
|
||||
"RASS" => ["PSI", "TS"],
|
||||
"PSI" => ["RASS", "TS"],
|
||||
"TS" => ["RASS", "PSI"],
|
||||
_ => new List<string> { "RASS", "PSI", "TS" }
|
||||
};
|
||||
|
||||
var result = await _observationService.Value.FindLastObservations(patientId.Value, 1, requiredObservations);
|
||||
var observations = result.ToDictionary(r => r.Name?.ToString() ?? "null");
|
||||
|
||||
if ((pobsName != "RASS" && (!observations.TryGetValue("RASS", out var rassObs) ||
|
||||
!int.TryParse(rassObs.Value.ToString(), out var rassValue) ||
|
||||
rassValue is not (-4 or -5))) ||
|
||||
(pobsName != "PSI" && (!observations.TryGetValue("PSI", out var psiObs) ||
|
||||
!int.TryParse(psiObs.Value.ToString(), out var psiValue) || psiValue >= 25)) ||
|
||||
(pobsName != "TS" && (!observations.TryGetValue("TS", out var tsObs) ||
|
||||
!int.TryParse(tsObs.Value.ToString(), out var tsValue) || tsValue <= 5)))
|
||||
return;
|
||||
|
||||
var treatments = await _treatmentService.Value.GetActiveTreatmentsByPatient(patientId.Value);
|
||||
if (!treatments.Any(ExceedsSedationThreshold)) return;
|
||||
|
||||
var overSedationObs = new PatientObservation
|
||||
{
|
||||
PatientId = patientId.Value,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = CodingSystem,
|
||||
Name = "Over_Sedation",
|
||||
Value = bool.TrueString
|
||||
};
|
||||
|
||||
await _observationService.Value.InsertObservation(overSedationObs, mapObs: false);
|
||||
}
|
||||
catch (Exception ex)
|
||||
{
|
||||
_logger.LogError("Error calculating Over_Sedation. Exception: {ex}", ex);
|
||||
throw;
|
||||
}
|
||||
}
|
||||
|
||||
private static bool ExceedsAnalgesiaThreshold(PatientTreatment? treatment)
|
||||
{
|
||||
// Perfusiones de morfina, remifentanilo o fentanilo sostenidas > 24 h
|
||||
|
||||
return treatment is { StartTime: not null } &&
|
||||
treatment.StartTime.Value.AddSeconds(86400) < DateTime.UtcNow;
|
||||
}
|
||||
|
||||
private static bool ExceedsSedationThreshold(PatientTreatment? treatment)
|
||||
{
|
||||
return (treatment != null &&
|
||||
treatment.RequestedGiveCodes.Any(c =>
|
||||
c.Text == "Propofol" && treatment.RequestedGiveAmountMinimum > 3)) ||
|
||||
(treatment != null && treatment.RequestedGiveCodes.Any(c =>
|
||||
c.Text == "Midazolam" && treatment.RequestedGiveAmountMinimum > 0.05)) ||
|
||||
(treatment != null && treatment.RequestedGiveCodes.Any(c =>
|
||||
c.Text == "Isoflorano" && treatment.RequestedGiveAmountMinimum > 10));
|
||||
}
|
||||
|
||||
private async Task<List<PatientTreatment>> CheckExpiredPatientTreatments(PatientTreatment treatment)
|
||||
{
|
||||
//si el tratamiento ha expirado actualizamos el OrderControl a DC y devolvemos las que siguen activas
|
||||
var result = new List<PatientTreatment>();
|
||||
var oldTreatments = await _treatmentService.Value.GetActiveTreatmentsByPatient(treatment.PatientId);
|
||||
|
||||
foreach (var t in oldTreatments.Where(t => t != null))
|
||||
if (t is { EndTime: not null } && t.EndTime > DateTime.UtcNow)
|
||||
{
|
||||
t.OrderControl = OrderControlType.Dc;
|
||||
_ = _treatmentService.Value.UpdateTreatment(t);
|
||||
}
|
||||
else if (t != null)
|
||||
{
|
||||
result.Add(t);
|
||||
}
|
||||
|
||||
|
||||
return result;
|
||||
}
|
||||
|
||||
private async Task CheckTreatmentMedicines(PatientTreatment treatment)
|
||||
{
|
||||
var newMedicines = (await Task.WhenAll(treatment.RequestedGiveCodes
|
||||
.Select(async code => await _medicineService.Value.GetByCode(code.Identifier))))
|
||||
.Where(m => m != null)
|
||||
.ToList();
|
||||
|
||||
if (newMedicines.Count == 0) return;
|
||||
|
||||
var activeTreatments = (await GetActiveTreatmentsByPatient(treatment.PatientId)).ToList();
|
||||
var activeMedicines = (await _medicineService.Value.GetMedicinesOfTreatments(activeTreatments)).ToList();
|
||||
|
||||
// Combina ambas listas y selecciona solo elementos únicos con el mismo nombre
|
||||
var uniqueMedicines = newMedicines
|
||||
.Concat(activeMedicines)
|
||||
.GroupBy(m => m?.Name)
|
||||
.Select(g => g.First())
|
||||
.ToList();
|
||||
|
||||
// uniqueMedicines contiene la lista de medicamentos activos de un paciente
|
||||
CheckMedicationCategories(treatment.PatientId, uniqueMedicines as List<Medicine>);
|
||||
}
|
||||
|
||||
private void CheckMedicationCategories(ObjectId patientId, List<Medicine> uniqueMedicines)
|
||||
{
|
||||
var medicationCategories = new Dictionary<string, List<string>?>
|
||||
{
|
||||
{ "Sedation_Medication_Multivalue", _sedationList },
|
||||
{ "Inotropic_Medication_Multivalue", _inotropicMedicines },
|
||||
{ "Antibiotic_Medication_Multivalue", _antibioticList },
|
||||
{ "Anxiolytic_Medication_Multivalue", _anxiolyticsList },
|
||||
{ "Antipsychotic_Medication_Multivalue", _antipsicoticList },
|
||||
{ "Antidepressants_Medication_Multivalue", _antidepressantsList },
|
||||
{ "Neuro_Medication_Multivalue", _neuroMedicationList },
|
||||
{ "Crystalloid_Serum_Medication_Multivalue", _serumCrystalloidList },
|
||||
{ "Colloid_Serum_Medication_Multivalue", _serumColloidList },
|
||||
{ "Antihypertensives_Medication_Multivalue", _antihypertensivesList }
|
||||
};
|
||||
|
||||
foreach (var category in medicationCategories)
|
||||
{
|
||||
var observations = uniqueMedicines?
|
||||
.Where(m => category.Value != null && !string.IsNullOrEmpty(m.Name) && m.Name != null &&
|
||||
category.Value.Contains(m.Name))
|
||||
.ToList();
|
||||
|
||||
if (observations != null && observations.Any())
|
||||
_ = CreateMedicationMultivalueObservation(observations, patientId, category.Key);
|
||||
}
|
||||
}
|
||||
|
||||
|
||||
private async Task CreateMedicationMultivalueObservation(IEnumerable<Medicine?> medications, ObjectId patientId,
|
||||
string obsName)
|
||||
{
|
||||
var newObs = new PatientObservation
|
||||
{
|
||||
PatientId = patientId,
|
||||
Name = obsName,
|
||||
CodingSystem = CodingSystem,
|
||||
Value = medications.Select(m => m?.Name).ToArray(),
|
||||
Time = DateTime.Now
|
||||
};
|
||||
|
||||
var lastObsList = await _observationService.Value.FindLastObservations(patientId, 1, [obsName]);
|
||||
var lastObs = lastObsList.FirstOrDefault();
|
||||
if (lastObs is { Expired: false })
|
||||
{
|
||||
//expiramos la anterior
|
||||
lastObs.Expired = true;
|
||||
_ = _observationService.Value.UpdateObservation(lastObs);
|
||||
}
|
||||
|
||||
await _observationService.Value.InsertObservation(newObs,
|
||||
mapObs: false); //mapObs:no volvemos a mapear la observación
|
||||
}
|
||||
}
|
||||
@@ -0,0 +1,711 @@
|
||||
using adas_core.Application.Services.Interfaces;
|
||||
using adas_core.Domain.Enums;
|
||||
using adas_core.Domain.Models;
|
||||
using adas_core.Domain.Models.AppSettings;
|
||||
using adas_core.Domain.Models.Pumps;
|
||||
using adas_core.Domain.Utils;
|
||||
using adas_core.Domain.Utils.Interfaces;
|
||||
using Microsoft.Extensions.DependencyInjection;
|
||||
using Microsoft.Extensions.Logging;
|
||||
using Microsoft.Extensions.Options;
|
||||
using MongoDB.Bson;
|
||||
|
||||
namespace adas_core.Application.Customizations.HUVH.UCIN;
|
||||
|
||||
public class CalculatedObservations : ICalculatedObservations
|
||||
{
|
||||
private const string Spo2PreObservationName = "SpO2";
|
||||
private const string Spo2PostObservationName = "SpO2_Post";
|
||||
|
||||
private const string Spo2PrePostObservationName = "SpO2_Pre_Post";
|
||||
private const string CodingSystem = "ADAS";
|
||||
|
||||
private readonly List<string> _complexityObservations =
|
||||
[
|
||||
"Respiratory_Device_Multivalue", "Intravenous_Routes_Multivalue", "Medication_Multivalue",
|
||||
"System_Multivalue", "Newborn_Weight", "Surgery_Multivalue"
|
||||
];
|
||||
|
||||
private readonly ILogger<CalculatedObservations> _logger;
|
||||
private readonly IMappingUtils _mappingUtils;
|
||||
private readonly Lazy<IMedicineService> _medicineService;
|
||||
private readonly Lazy<IObservationService> _observationService;
|
||||
|
||||
private readonly Lazy<ITreatmentService> _treatmentService;
|
||||
|
||||
|
||||
public CalculatedObservations(IServiceProvider serviceProvider)
|
||||
{
|
||||
_treatmentService = serviceProvider.GetRequiredService<Lazy<ITreatmentService>>();
|
||||
_medicineService = serviceProvider.GetRequiredService<Lazy<IMedicineService>>();
|
||||
_observationService = serviceProvider.GetRequiredService<Lazy<IObservationService>>();
|
||||
_logger = serviceProvider.GetRequiredService<ILogger<CalculatedObservations>>();
|
||||
|
||||
var apiSettings = serviceProvider.GetRequiredService<IOptions<ApiSettings>>(); //apiSettings;
|
||||
_mappingUtils = new MappingUtils(apiSettings);
|
||||
}
|
||||
|
||||
|
||||
public Task CalculateActiveBolus(ObjectId patientId)
|
||||
{
|
||||
throw new NotImplementedException();
|
||||
}
|
||||
|
||||
|
||||
public async Task<T?> Map<T>(T obs, bool onlyByName = false) where T : BasePatientObservation
|
||||
{
|
||||
if (obs.Name is "Intervention_In" or "Intervention_Out") await CalculateInterventionMultiValueObservation(obs);
|
||||
if (obs.Name is "Surgery") await CalculateMultiValueObservation(obs);
|
||||
if (obs.Name != null && _complexityObservations.Contains(obs.Name))
|
||||
{
|
||||
_logger.LogDebug("Mapping observation Complexity {obs}", obs);
|
||||
//TODO ver si hay un máximo de puntuación por grupo de observaciones
|
||||
_ = CalculateComplexity(obs);
|
||||
}
|
||||
|
||||
if (obs.Name is Spo2PreObservationName or Spo2PostObservationName)
|
||||
{
|
||||
_logger.LogDebug("Pre-post saturation observation {obs}", obs);
|
||||
_ = CalculateSaturation_DiffObservation(obs);
|
||||
}
|
||||
|
||||
if (obs.Name is "ALPS" or "NPASS_Sedation" or "NPASS_Analgesia") _ = CalculatePainScale(obs);
|
||||
|
||||
|
||||
if (obs.Name is "Last_Defecation") obs = (T)CalculateLastDefecationValue(obs);
|
||||
|
||||
return obs;
|
||||
}
|
||||
|
||||
|
||||
public async Task<PatientTreatment> Map(PatientTreatment treatment)
|
||||
{
|
||||
var order = treatment.PlacerOrder?.EntityIdentifier; //aquí almacenamos el número de orden
|
||||
if (string.IsNullOrEmpty(order)) return treatment;
|
||||
|
||||
//comprobamos el estado de los tratamientos anteriores
|
||||
var oldTreatments = await CheckExpiredPatientTreatments(treatment);
|
||||
|
||||
treatment.OrderControl = oldTreatments.Any() ? OrderControlType.Xo : OrderControlType.Nw;
|
||||
|
||||
if (treatment.EndTime != null)
|
||||
//el tratamiento ha expirado
|
||||
treatment.OrderControl = OrderControlType.Dc;
|
||||
|
||||
await CheckTreatmentMedicines(treatment);
|
||||
|
||||
return treatment;
|
||||
}
|
||||
|
||||
public async Task<PumpObservation> Map(PumpObservation pumpObservation)
|
||||
{
|
||||
return await Task.FromResult(pumpObservation);
|
||||
|
||||
}
|
||||
|
||||
public async Task CalculateMedicineObservation(List<Medicine> activeMedicines, ObjectId patientId)
|
||||
{
|
||||
var medicineObs = new PatientObservation
|
||||
{
|
||||
PatientId = patientId,
|
||||
Name = "Medication_Multivalue",
|
||||
CodingSystem = CodingSystem,
|
||||
Value = activeMedicines.Select(m => m.Name ?? string.Empty).Distinct().ToArray(),
|
||||
Time = DateTime.Now
|
||||
};
|
||||
|
||||
var lastMedicationsObs =
|
||||
await _observationService.Value.FindLastObservations(patientId, 1, ["Medication_Multivalue"]);
|
||||
var lastMedicationObs = lastMedicationsObs.FirstOrDefault();
|
||||
if (lastMedicationObs != null)
|
||||
{
|
||||
//expiramos la anterior
|
||||
lastMedicationObs.Expired = true;
|
||||
_ = _observationService.Value.UpdateObservation(lastMedicationObs);
|
||||
}
|
||||
|
||||
await _observationService.Value
|
||||
.InsertObservation(
|
||||
medicineObs); //mapObs:volvemos a mapear la observación para que pase por el cálculo de la complejidad
|
||||
}
|
||||
|
||||
public async Task<IEnumerable<PatientTreatment?>> GetActiveTreatmentsByPatient(ObjectId id)
|
||||
{
|
||||
var activeTreatments = await _treatmentService.Value.GetActiveTreatmentsByPatient(id);
|
||||
return activeTreatments;
|
||||
}
|
||||
|
||||
|
||||
public Task<PatientDiagnosis> Map(PatientDiagnosis diagnosis)
|
||||
{
|
||||
throw new NotImplementedException();
|
||||
}
|
||||
|
||||
|
||||
public async Task<PatientObservation?> FixTimeInconsistencyWithLast(PatientObservation newObservation)
|
||||
{
|
||||
if (string.IsNullOrEmpty(newObservation.Name))
|
||||
{
|
||||
_logger.LogError(
|
||||
"Error FixTimeInconsistencyWithLast. Observation name is null or empty. Observation: {newObservation}",
|
||||
newObservation);
|
||||
return newObservation;
|
||||
}
|
||||
|
||||
var lastObservations = await _observationService.Value.FindLastObservations(newObservation.PatientId, 1,
|
||||
[newObservation.Name]);
|
||||
var lastObservation = lastObservations.FirstOrDefault();
|
||||
|
||||
if (lastObservation != null && DateTime.Compare(
|
||||
new DateTime(lastObservation.Time.Year, lastObservation.Time.Month,
|
||||
lastObservation.Time.Day, lastObservation.Time.Hour,
|
||||
lastObservation.Time.Minute, lastObservation.Time.Second),
|
||||
new DateTime(newObservation.Time.Year, newObservation.Time.Month,
|
||||
newObservation.Time.Day, newObservation.Time.Hour,
|
||||
newObservation.Time.Minute, newObservation.Time.Second)
|
||||
) >= 0)
|
||||
newObservation.Time = lastObservation.Time.AddSeconds(1);
|
||||
|
||||
return newObservation;
|
||||
}
|
||||
|
||||
public Task<List<PatientObservation>> PreMapList(List<PatientObservation> listToInsert)
|
||||
{
|
||||
return Task.FromResult(listToInsert);
|
||||
}
|
||||
|
||||
public Task<PatientObservation> MapSourceAlarm(PatientObservation obs, PatientObservationAlarm alarmToInsert)
|
||||
{
|
||||
return Task.FromResult(obs);
|
||||
}
|
||||
|
||||
public Task SendAlarm(PatientObservation obs, string name, AlarmEnum.Name? code)
|
||||
{
|
||||
throw new NotImplementedException();
|
||||
}
|
||||
|
||||
private async Task CalculatePainScale(BasePatientObservation obs)
|
||||
{
|
||||
if (obs is not PatientObservation pobs) return;
|
||||
|
||||
|
||||
object valueObs;
|
||||
|
||||
switch (pobs.Name)
|
||||
{
|
||||
case "ALPS":
|
||||
valueObs = pobs.Value;
|
||||
break;
|
||||
case "NPASS_Sedation":
|
||||
{
|
||||
//Buscamos la complementaria "NPASS Analgesia"
|
||||
var analgesiaObs =
|
||||
await _observationService.Value.FindLastObservations(obs.PatientId, 1, ["NPASS_Analgesia"]);
|
||||
var analgesiaValue = analgesiaObs.FirstOrDefault()?.Value.ToString() ?? "0";
|
||||
|
||||
valueObs = $"{pobs.Value}/{analgesiaValue}";
|
||||
}
|
||||
break;
|
||||
case "NPASS_Analgesia":
|
||||
{
|
||||
//Buscamos la complementaria "NPASS Sedation"
|
||||
var sedationObs =
|
||||
await _observationService.Value.FindLastObservations(obs.PatientId, 1, ["NPASS_Sedation"]);
|
||||
var sedationValue = sedationObs.FirstOrDefault()?.Value.ToString() ?? "0";
|
||||
|
||||
valueObs = $"{sedationValue}/{pobs.Value}";
|
||||
}
|
||||
break;
|
||||
default:
|
||||
return;
|
||||
}
|
||||
|
||||
var painScaleObs = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = "ADAS",
|
||||
Name = "Pain_Scale",
|
||||
Value = valueObs
|
||||
};
|
||||
|
||||
_ = _observationService.Value.InsertObservation(painScaleObs, mapObs: false);
|
||||
}
|
||||
|
||||
private static BasePatientObservation CalculateLastDefecationValue(BasePatientObservation obs)
|
||||
{
|
||||
if (obs is not PatientObservation pobs) return obs;
|
||||
//Assign obs time to value
|
||||
//Convert the UTC DateTime to local time.
|
||||
var localTime = pobs.Time.ToLocalTime();
|
||||
|
||||
//Format the local time into a short date/time string.
|
||||
pobs.Value = localTime.ToString("dd/MM/yyyy HH:mm");
|
||||
|
||||
return pobs;
|
||||
}
|
||||
|
||||
|
||||
private async Task CalculateMultiValueObservation(BasePatientObservation obs)
|
||||
{
|
||||
//El valor de la observación es un array de strings
|
||||
if (obs is not PatientObservation pobs || string.IsNullOrEmpty(obs.Name)) return;
|
||||
|
||||
var newObsName = $"{obs.Name}_Multivalue";
|
||||
var actualObsInBd =
|
||||
await _observationService.Value.FindLastObservations(obs.PatientId, 1, [newObsName]);
|
||||
|
||||
|
||||
var newValue = new List<string>();
|
||||
|
||||
if (pobs.Value is not string stringValueName) return;
|
||||
|
||||
|
||||
if (actualObsInBd.Count > 0)
|
||||
if (actualObsInBd.First().Value is string[] oldValue)
|
||||
{
|
||||
oldValue = oldValue.Where(x => x != stringValueName).ToArray();
|
||||
newValue.AddRange(oldValue);
|
||||
}
|
||||
|
||||
newValue.Add(stringValueName);
|
||||
|
||||
if (newValue.Count == 0) return;
|
||||
|
||||
//Expiramos la anterior
|
||||
var actualObs = actualObsInBd.FirstOrDefault();
|
||||
if (actualObs != null)
|
||||
{
|
||||
actualObs.Expired = true;
|
||||
|
||||
await _observationService.Value.UpdateObservation(actualObs);
|
||||
}
|
||||
|
||||
var newObservation = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = CodingSystem,
|
||||
Name = newObsName,
|
||||
Value = newValue.ToArray()
|
||||
};
|
||||
|
||||
_logger.LogDebug(
|
||||
"Calculate {name}_Multivalue {outpatient} Insert Calculated {time} value {value}",
|
||||
newObsName, newObservation.PatientId, newObservation.Time,
|
||||
newObservation.Value.ToJson());
|
||||
|
||||
await _observationService.Value.InsertObservation(newObservation);
|
||||
}
|
||||
|
||||
private async Task CalculateInterventionMultiValueObservation(BasePatientObservation obs)
|
||||
{
|
||||
if (obs is not PatientObservation pobs || string.IsNullOrEmpty(obs.Name) ||
|
||||
pobs.Value is not string valueObs) return;
|
||||
|
||||
if (!GetInterventionValue(valueObs, out var r) || r == null) return;
|
||||
|
||||
var obsType = r.Value.type; //"Intravenous_Routes";
|
||||
var obsGroup = r.Value.Name; // "Vía arterial";
|
||||
var newObsName = $"{obsType}_Multivalue";
|
||||
|
||||
// Obtener la última observación multivalue
|
||||
var result = await _observationService.Value.FindLastObservations(obs.PatientId, 1, [newObsName]);
|
||||
var actualMultiValueObsInDb = result.FirstOrDefault(o => !o.Expired);
|
||||
|
||||
var oldValue = actualMultiValueObsInDb?.Value as string[] ?? [];
|
||||
var newValue = new List<string>(oldValue);
|
||||
|
||||
if (obs.Name.Contains("_In"))
|
||||
{
|
||||
//Por seguridad solo tomamos el último valor que nos llega
|
||||
//Puede ser que no se acuerden de cancelar el anterior antes de añadir un nuevo dispositivo y no puede haber dos dispositivos del mismo tipo activos al mismo tiempo
|
||||
if (obsType == "Respiratory_Device")
|
||||
newValue.Clear();
|
||||
|
||||
// Inserción dispositivo
|
||||
if (!oldValue.Contains(obsGroup))
|
||||
newValue.Add(obsGroup);
|
||||
}
|
||||
else if (obs.Name.Contains("_Out"))
|
||||
{
|
||||
// Retirada del dispositivo
|
||||
//Buscamos la inserción
|
||||
var name = $"{obs.Name.Split('_')[0]}_In";
|
||||
var inObs = await _observationService.Value.FindLastNotExpiredObservatonsByPatient(obs.PatientId, name);
|
||||
|
||||
var sameValueObs = inObs.Where(o => o.Value == pobs.Value).ToList();
|
||||
|
||||
if (sameValueObs.Any())
|
||||
// Si hay más de una observación del mismo tipo, no eliminar del multivalue
|
||||
if (sameValueObs.Count > 1)
|
||||
return;
|
||||
|
||||
// Actualizar valor eliminando el grupo
|
||||
newValue.Remove(obsGroup);
|
||||
}
|
||||
else
|
||||
{
|
||||
return;
|
||||
}
|
||||
|
||||
//Expiramos la anterior
|
||||
if (actualMultiValueObsInDb is { Expired: false })
|
||||
{
|
||||
actualMultiValueObsInDb.Expired = true;
|
||||
await _observationService.Value.UpdateObservation(actualMultiValueObsInDb);
|
||||
}
|
||||
|
||||
// Si no hay valores nuevos, no se crea una nueva observación
|
||||
if (!newValue.Any())
|
||||
return;
|
||||
|
||||
|
||||
// Crear y registrar nueva observación
|
||||
var newObservation = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = CodingSystem,
|
||||
Name = newObsName,
|
||||
Value = newValue.ToArray()
|
||||
};
|
||||
|
||||
_logger.LogDebug(
|
||||
"Calculate {name}_Multivalue {patientid} Insert Calculated {time} value {value}",
|
||||
newObsName, newObservation.PatientId, newObservation.Time,
|
||||
newObservation.Value.ToJson()
|
||||
);
|
||||
|
||||
await _observationService.Value.InsertObservation(newObservation);
|
||||
}
|
||||
|
||||
private bool GetInterventionValue(string valueObs, out (string type, string Name, string Group)? r)
|
||||
{
|
||||
var code = valueObs.Split(" ")[0]; //
|
||||
if (code.EndsWith(".")) // Verifica si termina con un punto
|
||||
code = code.Substring(0, code.Length - 1).Replace('.', ','); // Remueve el último carácter
|
||||
|
||||
if (!double.TryParse(code, out var codeParsed))
|
||||
{
|
||||
r = null;
|
||||
return false;
|
||||
}
|
||||
|
||||
|
||||
r = _mappingUtils.SearchByCode(codeParsed, "Intervention"); //TODO validar este parámetro con Lola
|
||||
|
||||
return r != null;
|
||||
}
|
||||
|
||||
|
||||
/**
|
||||
* Calculamos la complejidad basándonos en el valor de Respiratorio/Vías/Medicación/Sistemas/Peso nacimiento/cirugía
|
||||
* cuando entra una nueva observación que afecte a complejidad, se recalcula de 0 para no tener que estar pendiente de qué puntos corresponden a qué observación
|
||||
* Valor máximo 46 Guardamos la observación que nos llega y recalculamos complejidad.
|
||||
*/
|
||||
private async Task CalculateComplexity(BasePatientObservation obs)
|
||||
{
|
||||
var pobs = obs as PatientObservation;
|
||||
if (pobs == null) return;
|
||||
|
||||
var complexity = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = CodingSystem,
|
||||
Name = "Complexity",
|
||||
Value = 0
|
||||
};
|
||||
|
||||
var complexityValue = 0;
|
||||
|
||||
// Diccionario para manejar las operaciones basadas en el nombre de la observación
|
||||
var operations = new Dictionary<string, Func<ObjectId, PatientObservation?, Task<int>>>
|
||||
{
|
||||
{
|
||||
"Respiratory_Device_Multivalue",
|
||||
(patientId, observation) =>
|
||||
CalculateMultivalueObservationComplexityValue(patientId, "Respiratory_Device_Multivalue",
|
||||
observation)
|
||||
},
|
||||
{
|
||||
"Intravenous_Routes_Multivalue",
|
||||
(patientId, observation) =>
|
||||
CalculateMultivalueObservationComplexityValue(patientId, "Intravenous_Routes_Multivalue",
|
||||
observation)
|
||||
},
|
||||
{
|
||||
"Medication_Multivalue",
|
||||
(patientId, observation) =>
|
||||
CalculateMultivalueObservationComplexityValue(patientId, "Medication_Multivalue", observation)
|
||||
},
|
||||
{
|
||||
"System_Multivalue",
|
||||
(patientId, observation) =>
|
||||
CalculateMultivalueObservationComplexityValue(patientId, "System_Multivalue", observation)
|
||||
},
|
||||
{ "Newborn_Weight", CalculateWeightNewBornValue },
|
||||
{
|
||||
"Surgery_Multivalue",
|
||||
(patientId, observation) =>
|
||||
CalculateMultivalueObservationComplexityValue(patientId, "Surgery_Multivalue", observation)
|
||||
}
|
||||
};
|
||||
|
||||
// Realizar cálculos iterando sobre las operaciones
|
||||
foreach (var operation in operations)
|
||||
complexityValue += await operation.Value(pobs.PatientId, operation.Key.Equals(pobs.Name) ? pobs : null);
|
||||
|
||||
complexity.Value = Math.Min(complexityValue, 46); // Limitar el valor máximo a 46
|
||||
|
||||
_logger.LogDebug(
|
||||
"complexity for patient {patientid} => inserting complexity value: {complexityValue} for patient: {complexityPatientid} at time {fixedTimeComplexityTime}",
|
||||
complexity.PatientId, complexity.Value, complexity.PatientId, complexity.Time);
|
||||
|
||||
await _observationService.Value.InsertObservation(complexity, mapObs: false);
|
||||
}
|
||||
|
||||
private async Task<int> CalculateMultivalueObservationComplexityValue(ObjectId patientId, string observationName,
|
||||
PatientObservation? observation = null)
|
||||
{
|
||||
var result =
|
||||
await _observationService.Value.FindLastObservations(patientId, 1, [observationName]);
|
||||
var actualObsInBd = result.FirstOrDefault();
|
||||
|
||||
var valueObj = observation == null ? actualObsInBd?.Value : observation.Value;
|
||||
var valueList = valueObj as string[];
|
||||
|
||||
var valueToReturn = valueList?.Sum(v => _mappingUtils.GetComplexityValue(v)) ?? 0;
|
||||
|
||||
_logger.LogDebug(
|
||||
"complexity for patient {patientid} => observation: {observationName} plus complexity: {Value}", patientId,
|
||||
observationName, valueToReturn);
|
||||
|
||||
return valueToReturn;
|
||||
}
|
||||
|
||||
|
||||
private async Task<int> CalculateWeightNewBornValue(ObjectId patientId, PatientObservation? pobs = null)
|
||||
{
|
||||
var result =
|
||||
await _observationService.Value.FindLastObservations(patientId, 1, ["Newborn_Weight"]);
|
||||
var actualObsInBd = result.FirstOrDefault();
|
||||
|
||||
string? strValue;
|
||||
string? obsName;
|
||||
if (pobs == null)
|
||||
{
|
||||
if (actualObsInBd?.Value == null) return 0;
|
||||
|
||||
strValue = actualObsInBd.Value.ToString();
|
||||
obsName = actualObsInBd.Name;
|
||||
}
|
||||
else
|
||||
{
|
||||
if (pobs.Units == "kg") pobs = ParseWeight(pobs);
|
||||
|
||||
strValue = pobs.Value.ToString();
|
||||
obsName = pobs.Name;
|
||||
}
|
||||
|
||||
if (!double.TryParse(strValue, out var valueParsed) || obsName == null)
|
||||
return 0;
|
||||
|
||||
var weightNewBornValue = _mappingUtils.GetComplexityValue(obsName, valueParsed);
|
||||
|
||||
|
||||
_logger.LogDebug(
|
||||
"complexity for patient {patientid} => Weight_Newborn plus complexity: {Weight_NewbornValue}",
|
||||
patientId, weightNewBornValue);
|
||||
|
||||
return weightNewBornValue;
|
||||
}
|
||||
|
||||
private PatientObservation ParseWeight(PatientObservation obs)
|
||||
{
|
||||
if (!double.TryParse(obs.Value.ToString(), out var dValue))
|
||||
{
|
||||
_logger.LogError("Error casting weight Observation {obs}:", obs);
|
||||
return obs;
|
||||
}
|
||||
|
||||
obs.Units = "gr";
|
||||
obs.Value = dValue * 1000;
|
||||
return obs;
|
||||
}
|
||||
|
||||
|
||||
private async Task CalculateSaturation_DiffObservation(BasePatientObservation obs)
|
||||
{
|
||||
var toSearchList = new List<string>();
|
||||
PatientObservation? pre;
|
||||
PatientObservation? post;
|
||||
|
||||
toSearchList.AddRange(new List<string> { Spo2PreObservationName, Spo2PostObservationName });
|
||||
|
||||
var values = await _observationService.Value.FindLastObservations(obs.PatientId, 1, toSearchList);
|
||||
var time = obs.Time;
|
||||
|
||||
if (obs.Name == Spo2PreObservationName)
|
||||
{
|
||||
pre = (PatientObservation)obs;
|
||||
post = values.FirstOrDefault(o => o.Name == Spo2PostObservationName);
|
||||
|
||||
if (post?.Time != null && time.CompareTo(post.Time) > 0) time = post.Time;
|
||||
}
|
||||
else
|
||||
{
|
||||
post = (PatientObservation)obs;
|
||||
pre = values.FirstOrDefault(o => o.Name == Spo2PreObservationName);
|
||||
|
||||
if (pre?.Time != null && time.CompareTo(pre.Time) > 0) time = pre.Time;
|
||||
}
|
||||
|
||||
if (pre?.Value != null && post?.Value != null)
|
||||
{
|
||||
var preSuccess = double.TryParse(pre.Value.ToString(), out var preValue);
|
||||
if (!preSuccess) preValue = 0;
|
||||
var postSuccess = double.TryParse(post.Value.ToString(), out var postValue);
|
||||
if (!postSuccess) postValue = 0;
|
||||
|
||||
var saturationDiff = Math.Round(preValue - postValue, 2);
|
||||
|
||||
var saturationDiffObs = new PatientObservation
|
||||
{
|
||||
Name = "SpO2_Diff",
|
||||
CodingSystem = CodingSystem,
|
||||
PatientId = obs.PatientId,
|
||||
Time = time,
|
||||
Value = saturationDiff
|
||||
};
|
||||
var saturationPrePost = new PatientObservation
|
||||
{
|
||||
Name = Spo2PrePostObservationName,
|
||||
CodingSystem = CodingSystem,
|
||||
PatientId = obs.PatientId,
|
||||
Time = time,
|
||||
Value = pre.Value + "/" + post.Value
|
||||
};
|
||||
|
||||
await _observationService.Value.InsertObservation(saturationDiffObs);
|
||||
await _observationService.Value.InsertObservation(saturationPrePost);
|
||||
}
|
||||
}
|
||||
|
||||
private async Task<List<PatientTreatment>> CheckExpiredPatientTreatments(PatientTreatment treatment)
|
||||
{
|
||||
//si el tratamiento ha expirado actualizamos el OrderControl a DC y devolvemos las que siguen activas
|
||||
var result = new List<PatientTreatment>();
|
||||
var oldTreatments = await _treatmentService.Value.GetActiveTreatmentsByPatient(treatment.PatientId);
|
||||
|
||||
foreach (var t in oldTreatments)
|
||||
{
|
||||
if (t == null) continue;
|
||||
|
||||
if (t.PlacerOrder?.EntityIdentifier == treatment.PlacerOrder?.EntityIdentifier)
|
||||
{
|
||||
//Es el mismo tratamiento actualizamos
|
||||
|
||||
if (t.EndTime != null && t.EndTime > DateTime.UtcNow) treatment.OrderControl = OrderControlType.Dc;
|
||||
|
||||
treatment.Id = t.Id; //Asignamos el ID del tratamiento existente para actualizarlo
|
||||
_ = _treatmentService.Value.UpdateTreatment(treatment);
|
||||
}
|
||||
else
|
||||
{
|
||||
result.Add(t);
|
||||
}
|
||||
}
|
||||
|
||||
|
||||
return result;
|
||||
}
|
||||
|
||||
private async Task CheckTreatmentMedicines(PatientTreatment treatment)
|
||||
{
|
||||
var newMedicines = new List<Medicine>();
|
||||
var hasVasoactives = false;
|
||||
foreach (var code in treatment.RequestedGiveCodes)
|
||||
{
|
||||
var m = await _medicineService.Value.GetByCode(code.Identifier);
|
||||
if (m == null) continue;
|
||||
|
||||
//Si el código es de tipo nutrición entonces creamos una observación de ese tipo que tendrá el valor mapeado con el nombre correspondiente
|
||||
//CreateNutritionObservation y NO agregamos a medicamentos
|
||||
var r = _mappingUtils.SearchByCode(m.Codes.First(), "Treatment");
|
||||
if (r is { type: "Nutrition" })
|
||||
{
|
||||
await CreateNutritionObservation(r.Value.group, treatment.PatientId);
|
||||
continue;
|
||||
}
|
||||
|
||||
if (r is { type: "Medication", group: "Drogas vasoactivas" })
|
||||
hasVasoactives = true;
|
||||
|
||||
newMedicines.Add(m);
|
||||
}
|
||||
|
||||
if (hasVasoactives)
|
||||
{
|
||||
var vObs = new PatientObservation
|
||||
{
|
||||
Name = "HasVasoactive",
|
||||
Value = true,
|
||||
Time = DateTime.UtcNow,
|
||||
CodingSystem = CodingSystem
|
||||
};
|
||||
|
||||
await _observationService.Value.InsertObservation(vObs, mapObs: false);
|
||||
}
|
||||
|
||||
if (newMedicines.Count == 0)
|
||||
return;
|
||||
|
||||
var _ = await GetActiveTreatmentsByPatient(treatment.PatientId);
|
||||
|
||||
var activeTreatments = _.ToList();
|
||||
|
||||
var __ = await _medicineService.Value.GetMedicinesOfTreatments(activeTreatments); //Todo revisar
|
||||
var activeMedicines = __.ToList();
|
||||
|
||||
// Combina ambas listas y selecciona solo elementos únicos con el mismo nombre
|
||||
var uniqueMedicines = newMedicines
|
||||
.Concat(activeMedicines)
|
||||
.GroupBy(m => m.Name)
|
||||
.Select(g => g.First())
|
||||
.ToList();
|
||||
|
||||
await CalculateMedicineObservation(uniqueMedicines, treatment.PatientId);
|
||||
}
|
||||
|
||||
private async Task CreateNutritionObservation(string value, ObjectId patientId)
|
||||
{
|
||||
var nutritionObs = new PatientObservation
|
||||
{
|
||||
PatientId = patientId,
|
||||
Name = "Feeding_Type",
|
||||
CodingSystem = CodingSystem,
|
||||
Value = value,
|
||||
Time = DateTime.Now
|
||||
};
|
||||
|
||||
if (value.ToLower().Contains("parenteral"))
|
||||
{
|
||||
nutritionObs.Name = "Parenteral";
|
||||
nutritionObs.Value = "SI";
|
||||
}
|
||||
|
||||
var lastNutritionObsList =
|
||||
await _observationService.Value.FindLastObservations(patientId, 1, [nutritionObs.Name]);
|
||||
var lastNutritionObs = lastNutritionObsList.FirstOrDefault();
|
||||
if (lastNutritionObs is { Expired: false })
|
||||
{
|
||||
//expiramos la anterior
|
||||
lastNutritionObs.Expired = true;
|
||||
_ = _observationService.Value.UpdateObservation(lastNutritionObs);
|
||||
}
|
||||
|
||||
await _observationService.Value.InsertObservation(nutritionObs);
|
||||
}
|
||||
}
|
||||
Reference in New Issue
Block a user