Curso a distância sobre ciências básicas para especialização em Oftalmologia / Distance learning course on basic sciences for residency in Ophthalmology

RESUMO Objetivo Elaborar e validar um curso sobre Ciências Básicas em Oftalmologia. Métodos Foi realizado um estudo metodológico para elaboração e validação de material didático, na modalidade à distância, por meio do desenho instrucional ADDIE. O desenho é composto de três de cinco etapas: análise, desenho e desenvolvimento. Foi utilizada a taxonomia revisada de Bloom para definição dos objetivos de aprendizagem. O curso foi submetido à validação do conteúdo, via remota, por meio de grupo de consenso selecionado pelo modelo de Fehring, segundo as normas da resolução 510/2016. Resultados O curso elaborado e validado tem duração prevista de 15 horas e possui 19 objetivos de aprendizagem distribuído em seis unidades pedagógicas. Contempla o conteúdo programático utilizando diversos recursos tecnológicos interativos e apresenta-se com avaliações formativas de sedimentação do conteúdo ao fim de cada unidade. Conclusão O curso de Ciências Básicas em Oftalmologia na modalidade à distância validado promete democratizar o ensino da Oftalmologia às instituições de ensino credenciadas pelo Conselho Brasileiro de Oftalmologia.

ABSTRACT Objective To develop and validate a course on basic sciences in Ophthalmology. Methods A methodological study for the development and validation of a teaching and instructional material, an online course through the ADDIE instructional design, was prepared at the Faculdade Pernambucana de Saúde (FPS). The design consists of three steps out of five: Analysis, Design, and Development. Bloom's revised Taxonomy was used to define the learning objectives. The course was submitted remotely to content validation, through a consensus group of five specialists selected with a score higher than five in the criteria established by the Fehring model, according to the rules of Resolution 510/2016. Results With expected duration of 15 hours, the course has 19 learning objectives distributed in six pedagogical units. It contemplates the programmatic content using several interactive technological resources, such as storytelling videos, simulation with animated cartoons and clickable interactive actors and screens. In addition to having formative evaluation of content sedimentation at the end of each unit. Conclusions The online course of basic sciences in ophthalmology has been validated by specialists and it is expected to provide democratization of ophthalmology teaching to educational institutions accredited by the CBO.

The limited use of instructional design guidelines in healthcare simulation scenarios: an expert appraisal.

BACKGROUND: Systematic reviews on simulation training effectiveness have pointed to the need to adhere to evidence-based instructional design (ID) guidelines. ID guidelines derive from sound cognitive theories and aim to optimize complex learning (integration of knowledge, skills, and attitudes) and learning transfer (application of acquired knowledge and skills in the workplace). The purpose of this study was to explore adherence to ID guidelines in simulation training programs for dealing with postpartum hemorrhage (PPH), a high-risk situation and the leading cause of maternal mortality worldwide. METHODS: A total of 40 raters analyzed simulation training programs as described in 32 articles. The articles were divided into four subsets of seven articles and one subset of four articles. Each subset was judged by seven to ten raters on adherence to ID guidelines. The 5-point Likert score rating scale was based on Merrill's First Principles of Instruction and included items relating to key ID features categorized into five subscales: authenticity, activation of prior knowledge, demonstration, application, and integration/transfer. The authors searched for articles published in English between January 2007 and March 2017 in PubMed, Eric, and Google Scholar and calculated the mean Likert-scale score, per subscale, and interrater reliability (IRR). RESULTS: The mean Likert-scale scores calculated for all subscales were < 3.00. For the number of raters used to judge the papers in this study (varying between 7 and 10), the IRR was found to be excellent for the authenticity and integration/transfer subscales, good-to-excellent for the activation of prior knowledge and application subscales, and fair-to-good for the demonstration subscale. CONCLUSION: The results demonstrate a paucity of the description of adherence to evidence-based ID guidelines in current simulation trainings for a high-risk situation such as PPH.

The meaning attributed by tutors to experiences involving human rights in the academic environment / Significados atribuídos pelos docentes às vivências envolvendo direitos humanos no ambiente acadêmico

Abstract: Introduction: Human Rights are inherent to the human condition, considering all aspects of life: the right to life, to an education, to freedom, to religion, to security and to work. Given that, it is important to nurture a Human Rights culture in educational institutions, aiming at improving inter-personal dynamics and the educational environment. The tutors' development, in this aspect, becomes fundamental. Objective: To understand the meanings attributed by tutors to their experiences involving Human Rights situations in the academic environment as the first step to implement teacher development in this area. Methods: qualitative study involving tutors from a college located in northeastern Brazil, which employs the Problem-Based Learning methodology, between December of 2019 and September of 2020. The collection was performed through focal groups with intentional selection. The script for the discussion was based in the National Plan for Human Rights Education, The Human Rights Education Manual, The Universal Human Rights Declaration and articles related to the discussion topic. Bardin content analysis was used. The project was approved by the Ethics Committee under CAAE number 22696919.3.0000.5569. Results: The studied analytic categories were: gender and sexuality, communication and freedom of speech, social minorities and student self-esteem and stigmatization. During the process of reinterpreting the collected content, the following empirical subcategories were identified: ableism, fatphobia, psychophobia and interpersonal conflicts. The tutors revealed having experienced conflicts involving Human Rights, as follows: gender oppression; homophobia by students and teachers; lack of racial representativeness among the college student population; fatphobia in the academic environment; decrease in student's performance due to mental health issues. The participant tutors also expressed insecurity when it came to intervening and giving feedback in such situations, as well as some lack of knowledge about Human Rights. Conclusion: The tutors reported episodes that demonstrated Human Rights violation practices in the academic environment and showed to be insecure about intervening in such situations, especially when these situations led to conflict between the students.

Resumo: Introdução: Os direitos humanos (DH) são inerentes à condição humana, considerando todos os aspectos da vida: o direito à vida, à educação, à liberdade, à religião, à segurança e ao trabalho. Dessa forma, é importante incentivar a cultura dos DH nas instituições de ensino, na intenção de qualificar as dinâmicas interpessoais e o ambiente educacional. O desenvolvimento docente nesse aspecto torna-se fundamental. Objetivo: Este estudo teve como objetivo compreender os significados atribuídos pelos tutores às vivências envolvendo DH no ambiente acadêmico como primeiro passo para instituir o desenvolvimento docente nessa área. Método: Trata-se de um estudo qualitativo, realizado entre dezembro de 2019 e setembro de 2020, que envolveu tutores de uma faculdade do Nordeste do Brasil cuja metodologia de ensino é a Aprendizagem Baseada em Problemas. A coleta se deu por meio de grupos focais com seleção intencional. O roteiro para a discussão foi baseado no Plano Nacional de Educação em Direitos Humanos, no Caderno de Educação em Direitos Humanos, na Declaração de Direitos Humanos e em artigos referentes ao tema. Utilizou-se a análise de conteúdo de Bardin. O projeto recebeu parecer favorável do Comitê de Ética em Pesquisa: CAAE nº 22696919.3.0000.5569. Resultado: As categorias analíticas estudadas foram: gênero e sexualidade, comunicação e liberdade de expressão, minorias sociais e estigmatização e autoestima do estudante. Durante o processo de reinterpretação das falas, identificaram-se as seguintes subcategorias empíricas: capacitismo, gordofobia, saúde mental, psicofobia e conflitos interpessoais. Os docentes revelaram conflitos envolvendo DH, a exemplo das seguintes situações: opressão de gênero; homofobia por parte de docentes e estudantes; falta de representatividade racial na faculdade; gordofobia no ambiente acadêmico; queda de rendimento de estudantes por problemas de saúde mental. Expressaram insegurança em intervir e dar feedback em tais situações, bem como certo desconhecimento relacionado aos DH. Conclusão: Os docentes relataram episódios que demonstram práticas de violação aos DH no ambiente acadêmico e se mostraram inseguros para intervir nessas situações, sobretudo quando geravam conflito entre os estudantes.

Vivência materna frente à surdez do filho sob a perspectiva do narcisismo na teoria psicanalítica / Maternal experience regarding the deafness of the child under the perspective of narcissism in psychoanalytic theory / Vivencia materna frente a la sordera del hijo bajo la perspectiva del narcisismo en la teoría psicoanalítica

A deficiência auditiva é considerada uma das mais incapacitantes. A família de crianças deficientes enfrenta dificuldades inerentes à comunicação, aos conflitos, à afetividade e à integração infantil. Neste estudo, objetiva-se compreender como as mães vivenciaram a maternidade frente à surdez do filho, sob a perspectiva do narcisismo na teoria psicanalítica, num estudo qualitativo. Participaram deste estudo mães de crianças com surdez, em tratamento num serviço de implante coclear de um hospital de referência do Recife. Ao ser recebido pelas mães, o diagnóstico veio acompanhado de sofrimento emocional, impacto e fragilidade, afetando o narcisismo materno. Ainda assim, percebeu-se que as mães ficaram jubilosas ao apontarem a aquisição auditiva dos filhos possibilitada pelo implante coclear, indicando que este dispositivo pôde alinhavar o narcisismo materno, o qual, imaginariamente, recompõe o corpo. Enfatizamos que os profissionais de saúde precisarão respeitar o tempo lógico de elaboração pelo qual as mães passarão frente à surdez do filho.

Hearing deficiency is considered one of the most disabling. The family of disabled children faces inherent difficulties in communication, conflicts, affectivity, and child integration. The aim of this study was to understand how mothers experienced motherhood in the face of the deafness of the child, from the perspective of narcissism in psychoanalytic theory, in a qualitative study. The participants were mothers of deaf children undergoing treatment at a cochlear implant service at a reference hospital in Recife. The diagnosis was received by mothers with emotional suffering, impact and fragility affecting maternal narcissism. However, it was noticed that the mothers were jubilant to point to the children's auditory acquisition made possible by the cochlear implant, indicating that this device could nourish the maternal narcissism, which imaginatively recomposes the body. The health professionals will have to respect the logical time of elaboration, that mothers go through when facing the deafness of the child.

La deficiencia auditiva es considerada una de las más incapacitantes. La familia de niños discapacitados enfrentan dificultades inherentes a la comunicación, conflictos, afectividad, y la integración infantil. En este estudio se tiene como objetivo comprender como las madres tuvieron una vivencia de la maternidad frente a la sordera del hijo, bajo la perspectiva del narcisismo en la teoría psicoanalítica, en un estudio cualitativo. Participaron madres de niños con sordera en tratamiento, en un servicio de implante coclear de un hospital referido de Recife. El diagnóstico fue recibido por las madres con sufrimiento emocional, impacto y fragilidades afectando en el narcisismo materno. Todavía así, se percibió que las madres quedaron contentas al referirse a la adquisición auditiva de los hijos posibilitada por el implante coclear, indicando que este dispositivo podría tratar el narcisismo materno, el cual imaginariamente recompone el cuerpo. Los profesionales de la salud necesitaran respetar el tiempo lógico de elaboración que las madres pasarán frente a la sordera del hijo.

Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study.

Objective: To compare postpartum hemorrhage (PPH) patient outcomes before and after an in situ instructional design based PPH simulation attended by obstetrics and gynecology (OBGYN) residents.Methods: This uncontrolled before-and-after study was conducted in Recife, Brazil including all 1388 women delivering from June to August 2012 and all 1357 delivering from June to August 2013. The 36 OBGYN residents were divided into13 teams of two or three participants and were trained through ID based PPH simulation training with the following eight steps: (1) prior knowledge activation, (2) video demonstration, (3) dual-coding PPH protocol discussion-an image association during the training, (4) training scenario # 1, (5) debriefing, (6) training scenario # 2 with immediate feedback, (7) training scenario # 3, and (8) debriefing with self-assessment. The training scenarios had an increasing level of complexity. The main goal of the training was the adequate management of PPH and situational awareness improvement-the ability to anticipate, recognize, and intercept unfolding error chains. The primary patient outcomes rates used for the before and after comparison were therapeutic uterotonics use within 24 h of birth and blood transfusion. Secondary outcomes were therapeutic oxytocin mean dosage IU within 24 h of birth, postpartum Hb < 6 g/dL, among others. Chi-square test was used for categorical variables comparison and independent t-test for continuous variables.Results: PPH rates were 100 (7.2% of 2012 deliveries) and 80 cases (5.9% of 2013 deliveries), respectively. Comparison of primary post- and pre-simulation outcomes revealed no significant differences. However, in the comparison for therapeutic oxytocin mean dosage IU within 24 h of birth, there was an increase found after the simulation (15.98 ± 7.4 versus 25.1 ± 12.3; p < .001). For all other outcome measures, there were no statistical differences.Conclusions: In situ ID based PPH simulation leads to an increase in the mean dosage of oxytocin after training, in selected cases. This may indicate better situational awareness when managing women with PPH.

Correlação entre os domínios de competência do tutor e o desempenho estudantil: estudo transversal / Correlation between tutor domains of competency and student performance: a cross-sectional study

Resumo: Introdução: Na aprendizagem baseada em problemas, o tutor atua como facilitador, e, nesse contexto, as congruências social e cognitiva e o conhecimento do conteúdo são considerados aspectos fundamentais para o exercício dessa função. Objetivo: Este estudo teve como objetivo verificar o perfil de domínios de competências do tutor e a correlação com o desempenho do estudante. Método: Trata-se de um estudo transversal realizado de 2016 a 2017 com tutores e estudantes de Medicina da Faculdade Pernambucana de Saúde. Utilizou-se o coeficiente de Spearman para verificar a correlação do perfil de domínios de competência do tutor com o rendimento geral. Resultado: Participaram do estudo 34 tutores e 533 estudantes. Identificaram-se três domínios de competência nas frequências: congruência cognitiva em 88,7%, congruência social em 93,6% e conhecimento de conteúdo em 98,9%. Não foi observada correlação entre os domínios de competência e rendimento. Conclusão: Especula-se que esse achado se deva à falta de controle das variáveis de confundimento.

Abstract: Introduction: Problem-Based Learning involves the tutor acting as a facilitator, where social and cognitive congruence, as well as knowledge of the content are considered essential factors for the exercise. Objective: To verify tutors' domains of competency and their correlation to student performance. Method: Cross-sectional study conducted between February 2016 and 2017, with tutors and medical students from the Pernambuco School of Health. Correspondence analysis based on Spearman's correlation coefficient was used to ascertain the correlation between the tutor domains of competency profile and the overall performance. Results: The study included 34 tutors and 533 students, three domains of competency were identified within the frequencies: cognitive congruence in 88.7%, social congruence in 93.6% and content knowledge in 98.9%. No correlation was found between the domains of competency and performance. Conclusion: This finding is thought to be due to the lack of control of confounding variables.

Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus.

BACKGROUND: Very-low-birth-weight (VLBW) preterm neonates are vulnerable to patent ductus arteriosus (PDA), which might be related to high-resistance flow in the superior mesenteric artery (SMA), with decreased diastolic flow in situations of marked intestinal hypoperfusion. No previous studies have evaluated the portal vein and superior mesenteric vein (SMV) parameters to assess the PDA hemodynamic repercussions. OBJECTIVE: To assess mesenteric and portal flow in VLBW preterm neonates with or without PDA using serial Doppler ultrasonography (US). MATERIALS AND METHODS: We conducted a prospective longitudinal study on 61 VLBW preterm neonates submitted to 161 Doppler US exams, from 2 days to 20 days of age. RESULTS: All infants exhibited a progressive daily increase in the mean of the SMA diameter and systolic velocity, the portal vein diameter, the peak velocity, the mean velocity and the flow volume and of SMV diameter (P<0.05). The incidence of PDA was 37.7% (n=23) and infants with the disease revealed a smaller diameter, greater systolic velocity, lower diastolic velocity, and higher resistivity and pulsatility indices on SMA compared to those without PDA (P<0.05). Additionally, 47.8% (n=11) of infants with PDA exhibited absent or reversed end-diastolic flow in the SMA, and its resolution was seen among 54.5% (n=6) of these. Infants with PDA also exhibited lower values of portal vein diameter and flow volume and of SMV diameter (P<0.01). CONCLUSION: Doppler US enhances the understanding of mesenteric and portal flow, including the effects of PDA. The study of SMV and portal vein flow is proposed as a new parameter in PDA evaluation.

Intrinsic Motivation of Medical Students from a College with Active Methodology in Brazil: a Cross-Sectional Study / Motivação Intrínseca do Estudante de Medicina de uma Faculdade com Metodologia Ativa no Brasil: Estudo Transversal

ABSTRACT A cross-sectional study based on the Self Determination Theory to identify intrinsic motivation in the tutorial group scenario, and its associated factors in 276 medical students from a college in the Northeast of Brazil between October and December 2016. The Intrinsic Motivation Inventory was utilized following its adaptation and cross-cultural translation. Variables studied: age, gender, marital status, financial dependents, number of attempts at the university entrance exam for the medical course, current semester of study, previous undergraduate training, living with parents, choice of course by parental influence or pressure. Uni and multivariate Poisson analysis were carried out to assess the factors associated with intrinsic motivation; p <0.05 was considered as the significance level for statistical purposes. Average motivation score was 3.8, which indicates motivation. In 2 nd , 6 th and 10 th semester medicine students, the final model maintained as the variable associated with intrinsic motivation those who attempted the medical school entrance exam once or twice compared to those who had had three or more attempts (PR = 0.88, 95% CI (0.79-0.97), p = 0.011). In the analyses assessed by semester, in the second semester, students who had prior undergraduate training before medical school compared to those who had not was the remaining variable (PR = 0.92, 95% IC (0.87-0.97), p = 0.005). In the sixth semester, no statistically significant difference was found, and in the tenth semester the variable of those who attempted the medical school entrance exam once or twice remained (PR = 0.65, 95% IC (0.47-0.88), p = 0.006). The students seemed to be motivated in the group tutorial activity. The fewer number of medical school entry exam attempts and having previous undergraduate training were variables that showed association with intrinsic motivation.

RESUMO Estudo transversal baseado na Teoria da Autodeterminação para identificar a motivação intrínseca no cenário do grupo tutorial e seus fatores associados em 276 estudantes de Medicina de uma faculdade do Nordeste do Brasil entre outubro e dezembro de 2016, tendo sido utilizado o Inventário de Motivação Intrínseca, após sua tradução e adaptação transcultural. Variáveis estudadas: idade, sexo, estado civil, dependentes financeiros, número de tentativas no vestibular para ingresso no curso de Medicina, período em curso, graduação anterior, residência com os pais, escolha do curso por influência ou por pressão dos pais. Realizadas análises uni- e multivariada de Poisson para analisar os fatores associados à motivação intrínseca, foi considerado como nível de significância para fins estatísticos o valor p<0,05. O escore médio da motivação foi de 3,8, indicando motivação. Em estudantes do segundo, sexto e décimo períodos do curso de Medicina, permaneceram no modelo final como variável associada à motivação intrínseca aqueles que haviam realizado uma ou duas tentativas no vestibular, quando comparados aos estudantes que tinham realizado três ou mais tentativas (RP=0,88; IC95%(0,79-0,97); p = 0,011). Nas análises discriminadas por período, no segundo período, permaneceram no modelo final os estudantes que possuíam graduação anterior ao curso de Medicina, quando comparados aos que não possuíam (RP=0,92; IC95% (0,87-0,97); p = 0,005). No sexto período, nenhuma diferença estatisticamente significante foi encontrada; e no décimo período, a variável de ter realizado uma ou duas tentativas no vestibular (RP=0,65; IC95% (0,47-0,88); p = 0,006). Os estudantes se mostraram motivados na atividade do grupo tutorial. O menor número de tentativas no vestibular para ingresso no curso de Medicina e possuir graduação anterior foram variáveis que se mostraram associadas à motivação intrínseca.

Is doctor-patient relationship influenced by health online information?

SUMMARY OBJECTIVES To analyse the opinions and attitudes reported by medical specialists regarding online health information and their interference in the doctor-patient relationship. Methods A cross-sectional study developed between 2016 and 2017 in Recife-Pernambuco-Brazil, which used a questionnaire in person in a population of 183 specialists from the Instituto de Medicina Integral Prof. Fernando Figueira. The results were analysed through the Statistical Package for the Social Sciences. Obtained approval of the Ethics Committee under the voucher number 121004/2016. Results In the opinion of 85.2% of physicians, online health information has both positive and negative impacts on the physician-patient relationship. Faced with a questioning patient who claims to have researched information on the internet, 98.9% of the physicians said they would try to explain the reasons for their diagnosis and treatment. 59% already had a patient who modified the treatment recommended after seeing health information on the Internet. 73.8% agreed that online health information has positive effects for the general public, but 89.1% feel that most patients do not know which online health information is reliable CONCLUSION The physicians surveyed view online health information in a positive way, but realize that it is necessary to be cautious as to their repercussions on the treatment of patients. There is concern about the accuracy of online health information, and it is incumbent upon the physician and health institutions to instruct patients about the sources of quality and that they are able to understand, as its known the patients have an active voice through the guarantee of the ethical principle of autonomy.

RESUMO OBJETIVOS Analisar opiniões e atitudes relatadas por médicos especialistas diante das informações de saúde on-line e suas interferências na relação médico-paciente. Métodos Estudo transversal desenvolvido entre 2016 e 2017 em Recife, Pernambuco, Brasil, que utilizou um questionário presencialmente em uma população de 183 médicos especialistas do Instituto de Medicina Integral Prof. Fernando Figueira. Os resultados foram analisados por meio do Statistical Package for the Social Sciences. Obtida aprovação do Comitê de Ética sob o número de comprovante 121004/2016. Resultados Na opinião de 85,2% dos médicos, as informações on-line sobre saúde têm tanto impacto positivo quanto negativo na relação médico-paciente. Diante de um paciente questionador, que diz ter pesquisado informações na rede, 98,9% dos médicos fazem com que o usuário entenda as razões sobre seu diagnóstico e tratamento; 59% já tiveram paciente que modificou o tratamento recomendado por ter visto informações na internet; 73,8% concordam que as informações on-line sobre saúde têm efeitos positivos para o público em geral, mas 89,1% opinam que a maioria dos pacientes não sabe quais informações sobre saúde on-line são confiáveis. CONCLUSÃO Os médicos pesquisados veem as informações on-line sobre saúde de forma positiva, mas percebem que é necessário ter cautela quanto às repercussões destas sobre o tratamento dos pacientes. Há preocupação quanto à acurácia dessas informações, cabendo ao médico e às instituições de saúde instruir os pacientes quanto às fontes de qualidade e que estejam acessíveis ao entendimento de leigos, visto que os pacientes passaram a ter voz ativa por meio da garantia do princípio ético da autonomia.

Qualidade de vida, espiritualidade, religiosidade e esperança em pessoas com doença renal crônica em hemodiálise / Quality of life, spirituality, religiosity, and hope in chronic renal disease patients in hemodialysis

OBJETIVO: Analisar qualidade de vida, espiritualidade, religiosidade e esperança de pessoas com doença renal crônica em hemodiálise. MÉTODOS: Estudo de corte transversal realizado com pessoas acompanhadas no Instituto de Medicina Integral Prof. Fernando Figueira, em Recife (PE), entre agosto de 2016 a julho de 2017. Os dados referentes à qualidade de vida foram coletados por meio do instrumento World Health Organization Quality of Life ­ Spirituality, Religion and Personal beliefs (WHOQOL-SRPB-bref ), constituído por questões do tipo Likert, compondo cinco domínios, a saber: Físico, Psicológico, Relações Sociais, Meio Ambiente e Espiritualidade/Religiosidade/ Crenças Pessoais. Já os dados de esperança de vida foram coletados por meio da Escala de Esperança de Herth. RESULTADOS: O estudo envolveu 139 pacientes. Um bom indicador de qualidade de vida ocorreu nos domínios Espiritualidade/Religiosidade/ Crenças Pessoais (81,0%), Relações Sociais (75,8%), Psicológico (67,5%) e Meio Ambiente (64,4%). Já o domínio Físico apresentou o indicador mais baixo (58,3%) quando comparado aos demais. Com relação à esperança de vida, obteve-se variação de pontuação de 21 a 45, sendo 35 a mais frequente, significando alta esperança de vida na amostra em tela. CONCLUSÃO: Os indicadores de espiritualidade, religiosidade e esperança de vida se mostraram satisfatórios no grupo estudado. No contexto da doença renal crônica, estes aspectos surgem como medidas de enfrentamento positivo para as dificuldades da vida diária.(AU)

OBJECTIVES: To analyze quality of life, spirituality, religiosity, and hope in chronic kidney disease patients undergoing hemodialysis at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), located in the city of Recife, state of Pernambuco, Brazil. METHODS: A cross-sectional study was performed between August 2016 and July 2017. Quality of life data were collected through the WHOQOL-SRPB-bref, consisting of Likert-type questions, with five domains: Physical, Psychological, Social Relations, Environment, and Spirituality/ religiosity/personal beliefs. Life expectancy data were collected using Herth's Scale of Hope. RESULTS: The study involved 139 patients. A good indicator of good quality of life was observed in the spirituality/religiosity/personal beliefs (81,0%), social relations (75,8%), Psychological (67,5%), and Environment (64,4%) domains. The physical domain had the lowest indicator (58,3%) when compared to the others. Regarding life expectancy, scores ranged from 21 to 45, with 35 being the most frequent, indicating high hope in the group studied. CONCLUSIONS: The indicators of spirituality, religiosity and life expectancy were satisfactory in the group studied. In the context of chronic kidney disease, these aspects appear as positive coping measures of the difficulties of daily living.(AU)

Self-perceived long-term transfer of learning after postpartum hemorrhage simulation training.

OBJECTIVE: To explore long-term transfer (application of acquired knowledge and skills on the job) after postpartum hemorrhage simulation training based on either instructional design (ID) principles or conventional best practice. METHODS: In this qualitative study, semi-structured interviews with obstetrics and gynecology healthcare practitioners were conducted between August 7 and September 26, 2015, in Recife, Brazil. The participants were randomly selected from each of two postpartum hemorrhage simulations attended 2 years earlier (one ID and one conventional best practice). Thematic analysis was used to explore (1) residents' perceptions of long-term transfer of learning, (2) ID elements influencing the perceived long-term transfer, and (3) differences in the participants' perceptions according to the type of simulation attended. RESULTS: There were 12 interview participants. After either simulation format, residents perceived long-term transfer effects. Training design factors influencing transfer were, in their opinion, related to trainees' characteristics, simulation design, and workplace environment. Trainees who participated in the ID-based simulation perceived better communication skills and better overall situational awareness: "I didn't do that before." CONCLUSION: All residents perceived long-term transfer after simulation training for postpartum hemorrhage. Those who attended the ID format additionally perceived improvements in communication skills and situational awareness, which are fundamental factors in the management of postpartum hemorrhage.

Perspectivas sobre o uso das diretrizes de desenho instrucional para a simulação na saúde: revisão da literatura / Perspectives on the use of instructional design guidelines for health simulation: a literature review

OBJETIVOS: Este artigo teve dois objetivos principais: apresentar um breve resumo de conceitos cognitivos introdutórios sobre aprendizagem e instrução na simulação, incluindo as diretrizes de desenho instrucional; e oferecer uma visão geral quanto às evidências disponíveis sobre perspectivas instrucionais na efetividade da simulação na saúde, diferentes formatos instrucionais da simulação, fidelidade e local da simulação. MÉTODOS: Uma busca foi realizada nas bases de dados MEDLINE/PubMed, Embase, Cochrane, ERIC, LILACS e SciELO, a partir dos termos "simulação em saúde", "efetividade da simulação", "treinamento", "diretrizes de desenho instrucional", "aprendizagem complexa" e "transferência da aprendizagem" e seus correspondentes em inglês. O início das datas de publicação não foi especificado e a última busca foi conduzida em 19 de setembro de 2017. Todos os artigos em inglês e português foram considerados para inclusão. Artigos específicos foram intencionalmente incluídos em busca de conceitos introdutórios. RESULTADOS: A busca identificou 3.196 artigos nas diferentes bases de dados. Após avaliação preliminar de títulos, resumos e análise de conteúdo, foram selecionados 56 artigos. Adicionalmente, nove artigos clássicos e um livro foram intencionalmente incluídos para a apresentação de conceitos cognitivos sobre aprendizagem e instrução, resultando em 66 referências consultadas em detalhes para esta revisão. CONCLUSÕES: A simulação oferece a oportunidade de aprendizagem ativa para profissionais de saúde ao proporcionar um ambiente de aprendizagem complexa, com integração do conhecimento, habilidades e atitudes. Com potencial de impacto nos diferentes níveis de aprendizagem, comportamento e resultados, especial atenção deve ser dada ao formato instrucional da simulação. Entre as diretrizes de desenho instrucional, destaca-se a autenticidade como um dos elementos de fundamental relevância para a aprendizagem. Outros elementos instrucionais, como complexidade crescente, local do treinamento adequado, debriefing, oportunidade de autoavaliação e outras formas de avaliação, têm também influência positiva e devem ser utilizados no planejamento de diferentes desenhos instrucionais da simulação.

AIMS: This article had two main objectives: to present a brief summary of introductory cognitive concepts on learning and instruction for simulation, including instructional design guidelines; and provide an overview of the current available evidence on the instructional perspectives on healthcare simulation training effectiveness, in particular with regards to simulation formats, fidelity and simulation site. METHODS: We searched for articles at MEDLINE/PubMed, Embase, Cochrane, ERIC, LILACS and SciELO databases, using the keywords "instructional design guidelines", "healthcare simulation", "simulation training", "simulation effectiveness", "complex learning", and "transfer of learning". No specific beginning date of publication was specified and last date of search was September 19th 2017. All articles in English and Portuguese were considered for inclusion with no specific exclusion criteria. A few articles were purposefully selected in search of introductory concepts on learning and instruction. RESULTS: Our search retrieved 3196 articles in the different databases. After preliminary title, abstract and content analysis, we selected 56 articles. Additionally, nine traditional articles and one book were included to present the best available evidence, reviews, reflections and critiques on simulation instructional perspectives, resulting in 66 references consulted in detail for this review. CONCLUSIONS: Simulation offers the opportunity for active learning for health professionals by providing a complex learning environment with integration of knowledge, skills and attitudes. With potential impact on the different levels of learning, behavior and results, special attention should be given to the instructional format of the simulation. Among the instructional design guidelines, authenticity stands out as one of the elements of fundamental relevance for learning. Other instructional elements, such as increasing complexity, proper training location, debriefing, self-assessment opportunity, and other forms of assessment, also have positive influence and should be used in planning different simulation instructional designs.

Is doctor-patient relationship influenced by health online information?

OBJECTIVES: To analyse the opinions and attitudes reported by medical specialists regarding online health information and their interference in the doctor-patient relationship. METHODS: A cross-sectional study developed between 2016 and 2017 in Recife-Pernambuco-Brazil, which used a questionnaire in person in a population of 183 specialists from the Instituto de Medicina Integral Prof. Fernando Figueira. The results were analysed through the Statistical Package for the Social Sciences. Obtained approval of the Ethics Committee under the voucher number 121004/2016. RESULTS: In the opinion of 85.2% of physicians, online health information has both positive and negative impacts on the physician-patient relationship. Faced with a questioning patient who claims to have researched information on the internet, 98.9% of the physicians said they would try to explain the reasons for their diagnosis and treatment. 59% already had a patient who modified the treatment recommended after seeing health information on the Internet. 73.8% agreed that online health information has positive effects for the general public, but 89.1% feel that most patients do not know which online health information is reliable. CONCLUSION: The physicians surveyed view online health information in a positive way, but realize that it is necessary to be cautious as to their repercussions on the treatment of patients. There is concern about the accuracy of online health information, and it is incumbent upon the physician and health institutions to instruct patients about the sources of quality and that they are able to understand, as its known the patients have an active voice through the guarantee of the ethical principle of autonomy.

Anesthesiologists' knowledge about packed red blood cells transfusion in surgical patients / Conhecimento dos anestesiologistas sobre transfusão de concentrado de hemácias em pacientes cirúrgicos

Abstract Introduction Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the indications, adverse effects, and alternatives to red blood cell transfusion intraoperatively. Method Cross-sectional study using a questionnaire containing multiple choice questions and clinical cases related to relevant factors on the decision whether to perform PRBC transfusion, its adverse effects, hemoglobin triggers, preventive measures, and blood conservation strategies. The questionnaire was filled without the presence of the investigator. Likert scale was used and the average rank of responses was calculated. The Epi Info 7 software was used for data analysis. Results 79% of the institution's anesthesiologists answered the questionnaire; 100% identified the main adverse effects related to blood transfusion. When asked about the factors that influence the transfusion decision, hemoglobin level had the highest agreement (MR = 4.46) followed by heart disease (MR = 4.26); hematocrit (MR = 4.34); age (RM = 4.1) and microcirculation evaluation (MR = 4.22). Respondents (82.3%) identified levels of Hb = 6 g.dL-1 as a trigger to transfuse healthy patient. Regarding blood conservation strategies, hypervolemic hemodilution (MR = 2.81) and decided by drugs (MR = 2.95) were the least reported. Conclusion We identify a good understanding of anesthesiologists about PRBC transfusion; however, there is a need for refresher courses on the subject.

Resumo Introdução O sangue é importante recurso em diversas intervenções mantenedoras da vida, como corrigir a anemia e melhorar a capacidade de transporte de oxigênio. Apesar dos avanços, a transfusão de concentrado de hemácias (TCH) ainda envolve riscos. O objetivo deste estudo foi descrever o conhecimento dos anestesiologistas sobre as indicações, os efeitos adversos e as opções ao procedimento de transfusão de concentrado de hemácias no intraoperatório. Método Estudo transversal que usou questionário com perguntas de múltipla escolha e casos clínicos, referentes a fatores relevantes na decisão de transfundir concentrado de hemácias, seus efeitos adversos, gatilhos de hemoglobina, suas medidas preventivas e estratégias de conservação de sangue. Respondido sem a presença do pesquisador. Usada a escala de Likert e feito cálculo do ranking médio das respostas. Análise dos dados feita com programa Epi Info 7. Resultados Dos anestesiologistas da instituição, 79% responderam ao questionário e 100% identificaram os principais efeitos adversos relacionados à hemotransfusão. Questionados sobre os fatores que influenciariam na decisão de transfundir, o nível de hemoglobina obteve a maior concordância (RM = 4,46), seguido de cardiopatia (RM = 4,26), níveis de hematócrito (RM = 4,34), idade (RM = 4,1) e avaliação da microcirculação (RM = 4,22). Dos entrevistados, 82,3% identificaram níveis de Hb = 6 g.dL-1 como gatilho para transfundir paciente sadio. Quanto às estratégias de conservação de sangue, a hemodiluição hipervolêmica (RM = 2,81) e a deliberada por medicamentos (RM = 2,95) foram as menos citadas. Conclusão Identificou-se uma boa compreensão dos anestesiologistas a respeito da TCH. No entanto, há necessidade de cursos de atualização sobre o tema.

The use of instructional design guidelines to increase effectiveness of postpartum hemorrhage simulation training.

OBJECTIVE: To compare learning outcomes of postpartum hemorrhage simulation training based on either instructional design guidelines or best practice. METHODS: A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013. The instructional design group included 13 teams, whereas the best practice group included seven teams. A standardized task checklist was used for scenario analysis and the proportion of correctly executed tasks compared (post-test minus pretest). RESULTS: The instructional design group scored higher than the best practice group for total number of tasks completed (median difference 0.46 vs 0.17; P<0.001; effect size [r]=0.72). Similar results were observed for communication (median difference 0.56 vs 0.22; P=0.004; r=0.58), laboratory evaluation (median difference 0.83 vs 0.00; P<0.001; r=0.76), and mechanical management (median difference 0.25 vs -0.15; P=0.048; r=0.39). Speed of learning was also increased. The median differences were 0.20 for the instructional design group compared with 0.05 for the best practice group at 60 seconds (P=0.015; r=0.49), and 0.49 versus 0.26 (P=0.001; r=0.65) at 360 seconds. CONCLUSION: The use of simulation training for postpartum hemorrhage that was based on instructional design guidelines yielded better learning outcomes than did training based on best practice.

[Anesthesiologists' knowledge about packed red blood cells transfusion in surgical patients]. / Conhecimento dos anestesiologistas sobre transfusão de concentrado de hemácias em pacientes cirúrgicos.

INTRODUCTION: Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the indications, adverse effects, and alternatives to red blood cell transfusion intraoperatively. METHOD: Cross-sectional study using a questionnaire containing multiple choice questions and clinical cases related to relevant factors on the decision whether to perform PRBC transfusion, its adverse effects, hemoglobin triggers, preventive measures, and blood conservation strategies. The questionnaire was filled without the presence of the investigator. Likert scale was used and the average rank of responses was calculated. The Epi Info 7 software was used for data analysis. RESULTS: 79% of the institution's anesthesiologists answered the questionnaire; 100% identified the main adverse effects related to blood transfusion. When asked about the factors that influence the transfusion decision, hemoglobin level had the highest agreement (MR=4.46) followed by heart disease (MR=4.26); hematocrit (MR=4.34); age (RM=4.1) and microcirculation evaluation (MR=4.22). Respondents (82.3%) identified levels of Hb=6g.dL-1 as a trigger to transfuse healthy patient. Regarding blood conservation strategies, hypervolemic hemodilution (MR=2.81) and decided by drugs (MR=2.95) were the least reported. CONCLUSION: We identify a good understanding of anesthesiologists about PRBC transfusion; however, there is a need for refresher courses on the subject.

Epileptic seizures in children with congenital Zika virus syndrome / Crises epilépticas em crianças com síndrome congênita do Zika vírus

Abstract Objectives: to describe preliminary data referred to epileptic seizures and the probability of occurring these epileptic seizures in the infants' first months of life with congenital Zika virus (ZIKV) syndrome. Methods: concurrent cohort study including newborns and infants with congenital Zika virus syndrome attended at the specialized outpatient clinic at IMIP, Recife, Pernambuco, from October 2015 to May 2016. Results: data on 106 infants were analyzed with confirmed or suspected association to ZIKV infection. Forty children (38.7%) presented an epileptic seizure, classified at 43.3% of the cases as being spasms, 22.7% as generalized tonic seizures, 20.5% as partial and 4.5% other types of seizures. The median of days until the first report on the occurrence of epileptic seizure was 192 days of life. Conclusions: children with congenital Zika virus syndrome presented a high incidence of epileptic seizures before the end of the first semester of life, and spasm was the epileptic seizure mostly observed.

Resumo Objetivos: descrever dados preliminares referentes às crises epilépticas e à probabilidade de ocorrência dessas crises nos primeiros meses de vida em crianças com síndrome congênita do Zika vírus (ZIKV). Métodos: estudo de coorte concorrente incluindo recém-nascidos e lactentes com síndrome congênita do Zika vírus, atendidos no ambulatório especializado do IMIP, Recife, Pernambuco durante o período de outubro 2015 a maio 2016. Resultados: foram analisados dados de 106 lactentes com diagnóstico confirmado ou provável associação da infecção pelo ZIKV. Quarenta crianças (38,7%) apresentaram crise epiléptica, classificada em 43,3% dos casos como sendo espasmo, 22,7% como crise generalizada tônica, 20,5% parcial e 4,5% crises epilépticas de outros tipos. A mediana dos dias até o primeiro relato de ocorrência de crise epiléptica foi 192 dias de vida. Conclusões: crianças com síndrome congênita do Zika vírus apresentaram elevada incidência de crises epilépticas de aparecimento precoce, antes do final do primeiro semestre de vida, sendo o espasmo o tipo de crise mais observado.

Percepção do Estudante de Medicina acerca do Ambiente Educacional Utilizando o Dreem / Medical Students’ Views on the Learning Environment Using Dreem

RESUMO Introdução A percepção sobre o ambiente educativo pode influenciar o desempenho acadêmico, e a sua análise fornece subsídios importantes para melhorá-lo. Objetivo Avaliar a percepção do estudante acerca do ambiente educativo do Hospital Dom Malan/Imip durante o internato médico. Método Estudo do tipo survey, envolvendo 105 estudantes no período de abril a setembro de 2013. Foi utilizado o questionário Dundee Ready Education Environment Measure (Dreem). Resultados Foram considerados os seguintes resultados: questões individuais, as cinco dimensões e o Dreem global. A percepção geral foi considerada “more positive than negative” (pontuação 144,4/200), e a análise das dimensões revelou: percepção da aprendizagem: “a more positive perception”; percepção sobre os preceptores: “model course organisers” (49,5%); percepção dos resultados acadêmicos: “feeling more on the positive side” (70,5%); percepção do ambiente geral: “a more positive atitude” (55,2%); percepção das relações sociais: “not a nice place” (90,5%); e percepção geral do ambiente educativo: “more positive than negative” (69,5%). Não houve diferença estatisticamente significante quando comparados os dois grupos (p >0,05). Conclusões A percepção geral foi positiva, e a dimensão das relações sociais foi apontada como problemática.

ABSTRACT Introduction How quality of life and the educational environment are perceived can influence academic performance and its analysis can provide important insights. Objective To evaluate student’s perceptions about the learning environment of the Hospital Dom Malan/Imip during medical internship. Method Survey study involving 105 students between April and September 2013, based on the Dundee Ready Education Environment Measure (Dreem) questionnaire. Results The following results were considered: individual issues, the five dimensions and overall Dreem. The general perception was considered “more positive than negative” (score 144.4) and analysis of the dimensions revealed the following: perceptions of learning: “a more positive perception”; perception of preceptors: “model course organizers” (49.5%); perception of academic outcomes, “feeling more on the positive side” (70.5%); general perception of the environment: “a more positive attitude” (55.2%); perception of social relations: “not a nice place” (90.5%) and overall perception of the educational environment: “more positive than negative” (69.5%). There was no statistically significant difference when comparing the two groups (P >0.05). Conclusions The general perception was positive, and the dimension of social relations highlighted as problematic.

O exercício da função materna em mães de filhos obesos na perspectiva da psicanálise / The exercise of the maternal function in mothers of obese children from a psychoanalytical perspective / L’exercice de la fonction maternelle chez les mères d’enfants obèses dans la perspective de la psychanalyse / El ejercicio de la función materna en madres de niños obesos en la perspectiva del psicoanálisis

A pesquisa analisou as implicações da relação mãe bebê na obesidade, sob a perspectiva da teoria psicanalítica, com cinco mães de adolescentes obesos, em Recife PE, entre setembro e novembro/2013. Realizadas entrevistas individuais, semi estruturadas. Apontam-se impasses no exercício da função materna, criando obstáculos à resolução do processo de alienação separação, vivência da alternância presença ausência e reserva do lugar do pai na promoção da lei. Destaca-se a relevância de se considerar a complexa etiologia da obesidade e do seu caráter multifatorial, o que inclui a relação mãe bebê e suas implicações na obesidade dos filhos.

The implications of the mother-baby relationship on obesity were investigated from the point of view of the psychoanalytic theory. Semi-structured interviews were conducted with five mothers of obese adolescents in Recife-PE from September to November 2013. Deficiencies were observed in the exercise of the maternal function, creating obstacles regarding the resolution of the alienation-separation process, the experience of the presence-absence interchange, and the preservation of the father’s role in promoting the law. Results highlight the importance of taking into account the complex etiology of obesity and its multifactorial nature, which includes understanding the mother-infant relationship and its implications regarding obesity.

Notre recherche a analysé les effets de la relation mère-enfant sur l’obésité du point-de-vue de la théorie psychanalytique. Des entretiens individuels et semi-structurés ont été menés avec cinq mères d’adolescents obèses à Recife-PE de septembre à novembre 2013. Ils ont révélés des impasses dans l’exercice de la fonction maternelle et par conséquence des obstacles à la résolution du processus d’aliénation séparation, à l’expérience de l’alternance de la présence-absence et à la réservation du rôle du père en vue de la promotion de la loi. Nous soulignons l’importance de prendre en considération l’étiologie complexe de l’obésité et de son caractère multifactoriel, y compris le rapport mère-bébé et ses effets sur l’obésité des enfants.

La investigación analizó las implicaciones de la relación madre-hijo en la obesidad bajo la perspectiva de la teoría psicoanalítica, con cinco madres de adolescentes obesos, en Recife, Estado de Pernambuco (Brasil), entre septiembre y noviembre del 2013. Se llevaron a cabo encuestas individuales y semiestructuradas. Observados impases en el ejercicio de la función materna, se crearon obstáculos a la resolución del proceso de alienación-separación, a la vivencia de alternancia presencia-ausencia y a la reserva del lugar del padre en la promoción de la ley. Se destaca la importancia de considerar la compleja etiología de la obesidad y su multifactorial, incluyendo la relación madre-bebé y sus implicaciones en la obesidad de los hijos.

Reduction in Rotavirus Disease and Sustained Predominance of G2P[4] Rotavirus Strain following Introduction of Rotavirus Vaccine in Recife, Brazil.

Rotavirus vaccination was introduced in Brazil in March 2006. We describe the distribution of rotavirus genotypes in children with acute gastroenteritis in a hospital in Recife, Brazil, during pre- and post-vaccination periods. There was a 43.8% reduction in the proportion of diarrhea episodes due to rotavirus. Nevertheless, we observed a sustained predominance of G2P[4] as the main genotype identified in the post-vaccination period.