@peopl-health/nexus 5.68.11 → 5.68.12

package/lib/clinical/helpers/doctorReviewMessageHelper.js

@@ -21,10 +21,12 @@ function latestAlarm(review) {
 function flagsByStatus(sections) {
   const flags = (Array.isArray(sections?.redFlags) ? sections.redFlags : []).filter((flag) => inlineOf(flag?.flag));
   const named = (present) => flags.filter((flag) => flag.present === present).map((flag) => inlineOf(flag.flag));
+  const pending = flags.filter((flag) => typeof flag.present !== 'boolean');
   return {
     present: named(true),
     absent: named(false),
-    unassessed: flags.filter((flag) => typeof flag.present !== 'boolean').map((flag) => inlineOf(flag.flag)),
+    unassessed: pending.map((flag) => inlineOf(flag.flag)),
+    drugSafety: pending.filter((flag) => flag.blocksDrug !== false).map((flag) => inlineOf(flag.flag)),
   };
 }
 
@@ -49,13 +51,24 @@ function drugOf(symptom, item) {
 
 const proposedDrugs = ({ proposal }) => (proposal?.items ?? []).map((item) => drugOf(proposal.symptom, item)).filter(Boolean);
 
-function proposalLine({ proposal, withheldReason }) {
+function proposalLine({ proposal, withheldReason, conduct, sections }) {
   const drugs = proposedDrugs({ proposal });
-  if (!drugs.length) return `→ Sin propuesta de tratamiento: ${sentence(inlineOf(withheldReason) || 'requiere valoración médica')}`;
+  if (!drugs.length) {
+    const why = [withheldReason, conduct].map(inlineOf).filter(Boolean).map(sentence).join(' ');
+    return `→ Sin propuesta de tratamiento: ${why || '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(' ');
+  const { unassessed, drugSafety } = flagsByStatus(sections);
+  const lead = drugSafety.length
+    ? `→ Propuesta para su aprobación si se confirma sin ${drugSafety.join(', ')} (tabla ${table})`
+    : `→ Propuesta para su aprobación (tabla ${table})`;
+  return [
+    `${lead}: ${sentence(drugs.join('; '))}`,
+    unassessed.length && 'Si algo de lo pendiente es positivo: valoración presencial.',
+    declared.length && `Verificar: ${sentence(declared.join(', '))}`,
+  ].filter(Boolean).join(' ');
 }
 
 function symptomParagraph(entry, fallbackSymptom) {

package/lib/clinical/services/escalationDraftService.js

@@ -13,7 +13,7 @@ const { logger } = require('../../utils/logger');
 const { arrayArg, safeParse } = require('../../utils/jsonUtils');
 const { withTiming } = require('../../utils/tracingDecorator');
 
-const { crossSymptomIssues, unproposedDrugsIn, validateProposal } = require('./treatmentProposalService');
+const { crossSymptomIssues, drugsNamedIn, unproposedDrugsIn, validateProposal } = require('./treatmentProposalService');
 
 const CONVERSATION_TURNS = 40;
 const TRIAGE_LIMIT = 3;
@@ -22,11 +22,10 @@ const CALL_LOG_LIMIT = 10;
 const trimmed = (value) => String(value ?? '').trim();
 
 function withholdReason(sections) {
-  const { present, unassessed } = flagsByStatus(sections);
+  const { present } = flagsByStatus(sections);
   const modifiers = (Array.isArray(sections?.treatmentModifiers) ? sections.treatmentModifiers : []).map(trimmed).filter(Boolean);
   const reasons = [];
   if (present.length) reasons.push(present.length === 1 ? 'hay una bandera roja presente' : 'hay banderas rojas presentes');
-  if (unassessed.length) reasons.push(unassessed.length === 1 ? 'hay una bandera roja sin evaluar' : 'hay banderas rojas sin evaluar');
   if (modifiers.length) reasons.push(`condición que cambia el algoritmo (${modifiers.join(', ')})`);
   return reasons.join('; ') || null;
 }
@@ -35,8 +34,10 @@ function settleProposal(parsed) {
   const withheld = withholdReason(parsed);
   const raw = parsed?.treatmentProposal;
   const items = Array.isArray(raw?.items) ? raw.items : [];
-  if (withheld) return { proposal: null, withheldReason: withheld, strippedItems: items.length };
-  if (!items.length) return { proposal: null, withheldReason: trimmed(parsed?.proposalWithheldReason) || null, strippedItems: 0 };
+  const stated = trimmed(parsed?.proposalWithheldReason);
+  const conduct = stated && !drugsNamedIn(stated).length ? stated : null;
+  if (withheld) return { proposal: null, withheldReason: withheld, conduct, strippedItems: items.length };
+  if (!items.length) return { proposal: null, withheldReason: null, conduct, strippedItems: 0 };
 
   const conditions = Array.isArray(raw.conditions) ? raw.conditions : [];
   const ruledOut = Array.isArray(raw.ruledOut) ? raw.ruledOut : [];
@@ -154,7 +155,8 @@ async function generateEscalationDraft({
 
   const issues = settled.flatMap((entry) => entry.invalid ?? []);
   if (!issues.length) issues.push(...crossSymptomIssues(proposals));
-  const patientDrugs = unproposedDrugsIn(patientMessage, proposals);
+  const confirmed = settled.filter((entry) => entry.proposal && !flagsByStatus(entry.block).drugSafety.length).map((entry) => entry.proposal);
+  const patientDrugs = unproposedDrugsIn(patientMessage, confirmed);
   if (!issues.length && patientDrugs.length) {
     issues.push(`el mensaje al paciente menciona ${patientDrugs.join(', ')}, que no está en la propuesta de tratamiento`);
   }
@@ -167,7 +169,7 @@ async function generateEscalationDraft({
   const doctorText = composeDoctorBody({
     alarm: alarms[alarms.length - 1] ?? null,
     shared: parsed,
-    symptoms: settled.map(({ block, proposal, withheldReason }) => ({ sections: block, proposal, withheldReason })),
+    symptoms: settled.map(({ block, proposal, withheldReason, conduct }) => ({ sections: block, proposal, withheldReason, conduct })),
   });
 
   if (!doctorText || !patientMessage) {

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "@peopl-health/nexus",
-  "version": "5.68.11",
+  "version": "5.68.12",
   "description": "Core messaging and assistant library for WhatsApp communication platforms",
   "keywords": [
     "whatsapp",