@peopl-health/nexus 5.68.0 → 5.68.2

package/lib/clinical/helpers/doctorReviewMessageHelper.js

@@ -6,12 +6,12 @@ const URGENCY_LABELS = {
   stat: 'inmediata', asap: 'lo antes posible', urgent: 'urgente', routine: 'rutina',
 };
 
-const PROPOSAL_HEADING = 'Propuesta de tratamiento (sugerencia para su aprobación, no es una indicación):';
-const REQUESTED_ACTION = 'Acción solicitada: ¿aprueba la propuesta, la modifica o prefiere una valoración presencial?';
-const ASSESSMENT_ACTION = 'Acción solicitada: valoración médica prioritaria. ¿La valora en persona, la envía a urgencias o indica otra conducta?';
+const REQUESTED_ACTION = '¿Aprueba la propuesta, la modifica o prefiere una valoración presencial?';
+const ASSESSMENT_ACTION = 'Requiere valoración médica: ¿la valora en persona, la envía a urgencias o indica otra conducta?';
 const DOCTOR_TITLE = /^(dr|dra)\.?\s/i;
 
 const withTitle = (name) => (DOCTOR_TITLE.test(name) ? name : `Dr./Dra. ${name}`);
+const sentence = (text) => (/[.!?]$/.test(text) ? text : `${text}.`);
 
 function latestAlarm(review) {
   const alarms = Array.isArray(review?.alarms) ? review.alarms : [];
@@ -28,19 +28,6 @@ function flagsByStatus(sections) {
   };
 }
 
-function symptomLines(sections, stamp, fallbackSymptom = null) {
-  const grade = [1, 2, 3].includes(sections?.grade) ? `G${sections.grade}` : 'grado no establecido';
-  const said = [inlineOf(sections?.symptom) || fallbackSymptom || 'síntoma no especificado', grade, ...stamp].filter(Boolean);
-  const { present, absent, unassessed } = flagsByStatus(sections);
-  if (!present.length && !absent.length && !unassessed.length) return [`Síntoma: ${said.join(' · ')}`, 'Banderas rojas: no documentadas.'];
-  return [
-    `Síntoma: ${said.join(' · ')}`,
-    `Banderas rojas presentes: ${present.length ? present.join(', ') : 'ninguna'}.`,
-    `Banderas rojas ausentes: ${absent.length ? absent.join(', ') : 'ninguna revisada'}.`,
-    ...(unassessed.length ? [`Banderas rojas sin evaluar: ${unassessed.join(', ')}.`] : []),
-  ];
-}
-
 function vitalsLine(vitals) {
   const parts = [];
   if (vitals?.temperatureC != null) parts.push(`T ${vitals.temperatureC} °C`);
@@ -48,62 +35,66 @@ function vitalsLine(vitals) {
   if (vitals?.systolic != null || vitals?.diastolic != null) parts.push(`PA ${vitals.systolic ?? '?'}/${vitals.diastolic ?? '?'} mmHg`);
   if (vitals?.spo2 != null) parts.push(`SpO2 ${vitals.spo2}%`);
   if (vitals?.respiratoryRate != null) parts.push(`FR ${vitals.respiratoryRate} rpm`);
-  return parts.length ? `Signos vitales: ${parts.join(' · ')}.` : 'Signos vitales: no reportados.';
+  return parts.length ? `Signos vitales: ${parts.join(' · ')}.` : null;
 }
 
-function proposalItemLine(symptom, item) {
+function drugOf(symptom, item) {
   const entry = formularyFor(symptom);
   const drug = entry ? findDrug(entry, item) : null;
   if (!drug) return null;
-  const name = [drug.drug, drug.brand ? `(${drug.brand})` : null, drug.strength].filter(Boolean).join(' ');
-  const parts = [`- ${name}`];
-  if (drug.instructions) parts.push(drug.instructions);
-  parts.push(`posición en la tabla: ${drug.tableLabel}`);
-  const why = inlineOf(item?.justification?.text);
-  if (why) parts.push(`motivo: ${why}`);
-  return parts.join(' — ');
+  const name = [drug.drug, drug.strength].filter(Boolean).join(' ');
+  const why = inlineOf(item?.justification?.text)?.replace(/[.;]+$/, '');
+  return [drug.instructions ? `${name} (${drug.instructions})` : name, why && `motivo: ${why}`].filter(Boolean).join(', ');
 }
 
-function proposalBody({ proposal, withheldReason }) {
-  if (!proposal?.items?.length) {
-    const reason = inlineOf(withheldReason) || 'sin propuesta farmacológica';
-    return [`No se propone tratamiento sintomático: ${reason}. Se prioriza la valoración médica.`];
-  }
-  const lines = proposal.items.map((item) => proposalItemLine(proposal.symptom, item)).filter(Boolean);
-  const declared = [...(proposal.conditions ?? []), ...(proposal.ruledOut ?? []).map((key) => `descartado: ${key}`)].map(inlineOf).filter(Boolean);
-  if (declared.length) lines.push(`Condiciones que se declararon para esta propuesta (verificar): ${declared.join(', ')}.`);
-  return lines;
+const proposedDrugs = ({ proposal }) => (proposal?.items ?? []).map((item) => drugOf(proposal.symptom, item)).filter(Boolean);
+
+function proposalLine({ proposal, withheldReason }) {
+  const drugs = proposedDrugs({ proposal });
+  if (!drugs.length) return `→ Sin propuesta de tratamiento: ${sentence(inlineOf(withheldReason) || 'requiere valoración médica')}`;
+  const declared = [...(proposal.conditions ?? []), ...(proposal.ruledOut ?? []).map((key) => `descartado ${key}`)]
+    .map((key) => inlineOf(key)?.replace(/_/g, ' ')).filter(Boolean);
+  const table = formularyFor(proposal.symptom)?.label;
+  return [`→ Propuesta para su aprobación (tabla ${table}): ${sentence(drugs.join('; '))}`, declared.length && `Verificar: ${sentence(declared.join(', '))}`].filter(Boolean).join(' ');
 }
 
-function proposalHeading(entry, symptomName) {
-  const tableLabel = entry.proposal?.items?.length ? formularyFor(entry.proposal.symptom)?.label : null;
-  return tableLabel ? `${symptomName} (tabla: ${tableLabel})` : symptomName;
+function symptomParagraph(entry, fallbackSymptom) {
+  const sections = entry.sections ?? {};
+  const grade = [1, 2, 3].includes(sections.grade) ? `G${sections.grade}` : 'grado no establecido';
+  const { present, absent, unassessed } = flagsByStatus(sections);
+  const isUndocumented = !present.length && !absent.length && !unassessed.length;
+  const summary = inlineOf(sections.characterizationSummary);
+  return [
+    `${inlineOf(sections.symptom) || fallbackSymptom || 'Síntoma no especificado'} (${grade}):`,
+    summary && sentence(summary),
+    present.length && `${present.length > 1 ? 'Banderas rojas presentes' : 'Bandera roja presente'}: ${sentence(present.join(', '))}`,
+    unassessed.length && `Falta confirmar: ${sentence(unassessed.join(', '))}`,
+    isUndocumented && 'Banderas rojas no documentadas.',
+    !present.length && !unassessed.length && absent.length && 'Sin banderas rojas.',
+    proposalLine(entry),
+  ].filter(Boolean).join(' ');
 }
 
 function composeDoctorBody({ alarm, shared, symptoms }) {
-  const several = symptoms.length > 1;
-  const name = (entry) => inlineOf(entry.sections?.symptom) || 'Síntoma';
-  const stamp = [
-    URGENCY_LABELS[alarm?.urgencyLevel] ?? inlineOf(alarm?.urgencyLevel),
-    alarm?.raisedAt ? mexicoStamp(alarm.raisedAt) : null,
-  ];
   const context = shared?.oncologyContext;
-  const value = (text) => inlineOf(text) || 'no disponible';
+  const treatment = inlineOf(context?.treatment);
+  const lastDose = inlineOf(context?.lastDose);
+  const priorManagement = inlineOf(context?.priorManagement);
+  const response = inlineOf(context?.response);
+  const urgency = [URGENCY_LABELS[alarm?.urgencyLevel] ?? inlineOf(alarm?.urgencyLevel), alarm?.raisedAt ? mexicoStamp(alarm.raisedAt) : null].filter(Boolean);
+  const priorities = inlineOf(shared?.doctorPriorities);
   return [
-    ...symptoms.flatMap((entry, index) => symptomLines(entry.sections, index === 0 ? stamp : [], several ? null : inlineOf(alarm?.symptom))),
-    '',
-    ...symptoms.map((entry) => `${several ? `Caracterización (${name(entry)})` : 'Caracterización'}: ${inlineOf(entry.sections?.characterizationSummary) || 'no disponible'}`),
+    urgency.length ? `Urgencia: ${urgency.join(' · ')}` : null,
+    `Tratamiento: ${treatment || 'no disponible'}; última dosis ${lastDose || 'no disponible'}.`,
+    priorManagement || response ? `Manejo previo: ${sentence([priorManagement, response && `respuesta ${response}`].filter(Boolean).join('; '))}` : null,
     vitalsLine(shared?.vitals),
-    ...(inlineOf(shared?.objectiveData) ? [`Datos objetivos: ${inlineOf(shared.objectiveData)}`] : []),
-    '',
-    `Contexto oncológico: tratamiento ${value(context?.treatment)}; última dosis ${value(context?.lastDose)}.`,
-    `Manejo previo y respuesta: ${value(context?.priorManagement)}; respuesta ${value(context?.response)}.`,
+    inlineOf(shared?.objectiveData) ? `Datos objetivos: ${sentence(inlineOf(shared.objectiveData))}` : null,
     '',
-    PROPOSAL_HEADING,
-    ...symptoms.flatMap((entry) => (several ? [`${proposalHeading(entry, name(entry))}:`, ...proposalBody(entry)] : proposalBody(entry))),
+    ...symptoms.map((entry) => symptomParagraph(entry, symptoms.length > 1 ? null : inlineOf(alarm?.symptom))),
     '',
-    symptoms.some((entry) => entry.proposal?.items?.length) ? REQUESTED_ACTION : ASSESSMENT_ACTION,
-  ].join('\n');
+    priorities ? `Prioridades: ${sentence(priorities)}` : null,
+    symptoms.some((entry) => proposedDrugs(entry).length) ? REQUESTED_ACTION : ASSESSMENT_ACTION,
+  ].filter((line) => line !== null).join('\n');
 }
 
 function identityLines({ identity, review }) {

package/lib/services/escalationReviewService.js

@@ -23,7 +23,6 @@ const {
 const { getPatientAuditLog } = require('../models/patientAuditLogModel');
 const { isWithin24HourWindow } = require('../helpers/conversationWindowHelper');
 const { ensureWhatsAppFormat } = require('../helpers/twilioHelper');
-const { sendMessage } = require('../core/NexusMessaging');
 const { generateEscalationDraft } = require('../clinical/services/escalationDraftService');
 const { conversationLink, recordEmergency, writeUnresolvedRequest } = require('../clinical/services/clinicalAirtableService');
 const { renderDoctorMessage, templateSummary, withIdentity } = require('../clinical/helpers/doctorReviewMessageHelper');
@@ -39,6 +38,8 @@ const { getEscalationApprover, listEscalationApprovers } = require('./physicianS
 const { switchThreadStoppedStatus } = require('./threadService');
 const { effectiveUrgencyOf, responseDeadlineOf, responseDeadlinePolicy } = require('./reviewDeadlineService');
 
+const getMessaging = () => require('../core/NexusMessaging');
+
 const AUDIT_SOURCE = 'escalation_review';
 const RECENT_REVIEW_LIMIT = 20;
 const TIMELINE_LIMIT = 500;
@@ -367,7 +368,7 @@ async function sendDoctorAlert({ message, approver, operator }) {
   const outgoing = inWindow
     ? { code: doctorCode, body: message.body, triggeredBy: operator }
     : { code: doctorCode, contentSid: configured('ESCALATION_REVIEW_DOCTOR_ALERT_IDENTIFIED_CONTENT_SID'), variables: message.template, triggeredBy: operator };
-  const result = await sendMessage(outgoing);
+  const result = await getMessaging().sendMessage(outgoing);
   if (!result?.success && !result?.completed) {
     throw httpError(502, 'The WhatsApp message to the physician could not be sent');
   }
@@ -1608,7 +1609,7 @@ async function sendApprovedIndications({ id, outsideWindowRoute = null, sentBy,
 
   let result;
   try {
-    result = await sendMessage(message);
+    result = await getMessaging().sendMessage(message);
     const alreadyDelivered = result?.status === 'duplicate_suppressed' && result?.completed === true;
     if (!result?.success && !alreadyDelivered) {
       throw httpError(502, 'The indications could not be sent to the patient');

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "@peopl-health/nexus",
-  "version": "5.68.0",
+  "version": "5.68.2",
   "description": "Core messaging and assistant library for WhatsApp communication platforms",
   "keywords": [
     "whatsapp",