Medical education in times of COVID - 19: an experience at Faculdade Pernambucana da Saúde / Educação médica em tempos de COVID - 19: a experiência da Faculdade Pernambucana da Saúde

Abstract Objectives: to describe and discuss interventions and strategies carried out at Faculdade Pernambucana de Saúde (FPS) during the COVID-19 pandemic to mitigate impairment in learning and preserve students, tutors, and staff's health. Experience report: the teaching methodology used by FPS is problem-based learning, which greatly facilitated the non-discontinuity of theoretical activities carried out in-person in tutorial sessions involving a tutor and 10 to 12 students. This format was transferred to Webex Meetings rooms and held remotely. Practical laboratory activities were suspended and resumed when allowed in July. The teaching outpatient activities (third and fourth year) were suspended and resumed in August. Two years of internship were interrupted for 30 days (fifth year) and for 15 days (sixth year). External activities of practices in primary care were also suspended and resumed gradually. All assessments and activities that required face-to-face meetings, integrations, scientific initiation program orientations, collegiate meetings, meetings of the self-assessment committee were and are being carried out remotely. Conclusions: we believe that we were able to mitigate impairment in students' learning without compromising the conclusion of the school year that was facilitated by Problem Based Learning method.

Resumo Objetivo: descrever e discutir intervenções e estratégias realizadas pela Faculdade Pernambucana de Saúde (FPS) durante a pandemia de COVID-19 para atenuar prejuízos no aprendizado e preservar a saúde de estudantes, docentes e funcionários. Relato de experiência: a metodologia de ensino usada pela FPS é a aprendizagem baseada em problemas, que facilitou a não descontinuidade das atividades teóricas realizadas presencialmente em sessões tutoriais que envolvem um docente e dez a 12 estudantes, que foram transferidas para salas de Webex Meetings de forma remota. As atividades de laboratórios práticas foram suspensas e retomadas quando permitido no mês de julho. As atividades de ambulatório de ensino (terceiro e quarto ano) foram suspensas e retomadas em agosto. Os dois anos de internato sofreram interrupção de 30 dias (quinto ano) e 15 dias (sexto ano). As atividades externas de práticas em atenção primária também foram suspensas e retomadas gradativamente. Todas as avaliações e atividades que necessitavam reuniões presenciais: integrações, orientações de programa de iniciação científica, reuniões colegiadas, reuniões da comissão própria de autoavaliação foram e estão sendo realizadas de forma remota. Conclusões: acreditamos que conseguimos minimizar os prejuízos no aprendizado dos estudantes sem comprometimento de conclusão do ano letivo que foi facilitado pela metodologia de aprendizagem baseada em problemas.

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.

Non-Hodgkin's lymphoma in childhood: clinical and epidemiological characteristics and survival analysis at a single center in Northeast Brazil.

OBJECTIVE: To describe the clinical and demographic characteristics of non-Hodgkin's lymphoma patients diagnosed at the Pediatric Oncology Unit at the Instituto Materno-Infantil Professor Fernando Figueira (IMIP) over a 9-year period, and also to describe their survival rates and possible associations between the survival rates and the clinical and demographic characteristics analyzed in the study. METHODS: This was a cross-sectional study. Data were collected by a retrospective review of the charts of all 110 patients admitted to our unit during the period of May 1994 through May 2003. Probability of survival was calculated in accordance with the techniques of Kaplan-Meier, using log rank to evaluate differences between the groups. RESULTS: The average age was 6.1 years. The male/female ratio was 2.4:1. The most frequent histological subtype was Burkitt's lymphoma. The majority of patients had been diagnosed with advanced disease (stage III or IV of Murphy's Classification) and was from rural areas. Family income per capita was lower than 1/2 minimum wage in 36.4% of cases; maternal illiteracy was observed in 12.7% of cases. The 5-year overall survival and disease-free survival rates were 70+/-4% and 68.4+/-4%, respectively. None of the clinical-demographic characteristics had a significant association with the probability of survival (p > 0.05). CONCLUSION: Children admitted to the IMIP seemed to be affected by non-Hodgkin lymphoma at a younger age, with a higher incidence of Burkitt's lymphoma and with survival rates similar to those described in the literature of developed countries. No clinical demographic characteristics had a statistically significant association with prognosis

Linfoma não-Hodgkin na infância: características clínico-epidemiológicas e avaliação de sobrevida em um único centro no Nordeste do Brasil / Non-Hodgkin's lymphoma in childhood: clinical and epidemiological characteristics and survival analysis at a single center in Northeast Brazil

OBJETIVO: Descrever o perfil clínico-epidemiológico dos pacientes portadores de linfoma não-Hodgkin diagnosticados no Serviço de Oncologia Pediátrica do Instituto Materno-Infantil Professor Fernando Figueira em um período de 9 anos, bem como descrever sobrevida e possíveis associações prognósticas com as variáveis clínico-epidemiológicas estudadas. MÉTODOS: Estudo descritivo de corte transversal, realizado através da análise dos prontuários de 110 pacientes com linfoma não-Hodgkin admitidos na instituição no período de maio de 1994 a maio de 2003. As sobrevidas global e livre de doença foram analisadas através da técnica de Kaplan-Meier, e o teste de log rank foi utilizado para avaliar diferenças entre os grupos. RESULTADOS: A idade média foi de 6,1 anos, e a relação masculino-feminino, 2,4:1. O subtipo histológico mais freqüente foi o linfoma de Burkitt. A maioria dos pacientes foi diagnosticada em estádio III e IV da classificação de Murphy e provinha da zona rural. Renda familiar per capita inferior a 1/2 salário mínimo foi observada em 36,4 por cento, e analfabetismo materno, em 12,7 por cento dos casos. A probabilidade de sobrevida global e livre de doença aos 5 anos foi de 70±4 por cento e 68±4 por cento, respectivamente. Nenhuma das variáveis clínico-epidemiológicas analisadas mostrou associação estatística significante com a probabilidade de sobrevida dos pacientes (p > 0,05). CONCLUSÃO: Observamos incidência mais elevada do subtipo Burkitt e de crianças acometidas em idade mais jovem quando comparada à descrita em literatura estrangeira. A sobrevida observada aproximou-se dos resultados descritos pelos principais grupos cooperativos de tratamento de câncer infantil. As variáveis clínico-epidemiológicas analisadas não apresentaram associação prognóstica estatística significante.

OBJECTIVE:To describe the clinical and demographic characteristics of non-Hodgkin's lymphoma patients diagnosed at the Pediatric Oncology Unit at the Instituto Materno-Infantil Professor Fernando Figueira (IMIP) over a 9-year period, and also to describe their survival rates and possible associations between the survival rates and the clinical and demographic characteristics analyzed in the study. METHODS:This was a cross-sectional study. Data were collected by a retrospective review of the charts of all 110 patients admitted to our unit during the period of May 1994 through May 2003. Probability of survival was calculated in accordance with the techniques of Kaplan-Meier, using log rank to evaluate differences between the groups. RESULTS:The average age was 6.1 years. The male/female ratio was 2.4:1. The most frequent histological subtype was Burkitt's lymphoma. The majority of patients had been diagnosed with advanced disease (stage III or IV of Murphy's Classification) and was from rural areas. Family income per capita was lower than 1/2 minimum wage in 36.4 percent of cases; maternal illiteracy was observed in 12.7 percent of cases. The 5-year overall survival and disease-free survival rates were 70±4 percent and 68.4±4 percent, respectively. None of the clinical-demographic characteristics had a significant association with the probability of survival (p > 0.05). CONCLUSION: Children admitted to the IMIP seemed to be affected by non-Hodgkin lymphoma at a younger age, with a higher incidence of Burkitt's lymphoma and with survival rates similar to those described in the literature of developed countries. No clinical demographic characteristics had a statistically significant association with prognosis.

Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína / Comparison among three techniques of postoperative regional analgesia with ropivacaine in children

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória acarreta um aumento nos gastos e gera insatisfação dos pais com relação à prescrição analgésica para os seus filhos. A ropivacaína apresenta larga margem de segurança em anestesia regional em pediatria. O objetivo deste estudo foi comparar a anestesia peridural sacra (PS) com o bloqueio dos nervos ileoinguinal/ileohipogástrico (BIHII) e com a infiltração da ferida operatória (IFO) utilizando a ropivacaína para a analgesia pós-operatória em crianças. MÉTODO: Foram estudadas 87 crianças do sexo masculino, com idade entre 1 e 5 anos, submetidas a herniorrafias inguinais eletivas unilaterais. As crianças receberam de forma aleatória a PS, o BIHII ou a IFO. Pesquisou-se a necessidade de analgésico no pós-operatório, o tempo necessário para a sua 1ª dose, a intensidade da dor e o grau de bloqueio motor. RESULTADOS: No Grupo da IFO observou-se maior necessidade de analgésicos, e maior intensidade de dor nas primeiras duas horas, quando comparada com a PS e com o BIHII. Apenas crianças submetidas a PS apresentaram bloqueio motor de grau leve. O tempo médio da necessidade da 1ª dose de analgésico foi semelhante entre os grupos. CONCLUSÕES: O BIHII apresentou superioridade sobre a IFO, sobretudo nas primeiras duas horas de pós-operatório. As três técnicas anestésicas podem ser utilizadas com segurança e eficácia no controle da dor pós-operatória de herniorrafia inguinal em crianças.

BACKGROUND AND OBJECTIVES: Postoperative pain increases cost and generates dissatisfaction among parents regarding to the analgesics prescribed to their children. Ropivacaine has a broad safety margin to be used for regional block in pediatric patients. The aim of this study was to compare caudal epidural block (CE) with ilioinguinal/iliohypogastric nerve block (IINB) and infiltration of surgical wound (ISW) with ropivacaine for postoperative analgesia in children. METHODS: Eighty-seven children, all males, ages 1 to 5, who underwent elective unilateral inguinal herniorrhaphy participated in this study. Children were randomly assigned to receive CE, IINB, or ISW. The need for postoperative analgesia, length of time until the first dose, severity of pain, and degree of the motor blockade were evaluated. RESULTS: The need for analgesia and pain severity in the first two hours were greater for the ISW Group when compared with the CE and IINB Groups. Only the children in the CE Group presented a mild motor blockade. The mean length of time until de 1st dose of analgesic was similar in all groups. CONCLUSIONS: Ilioinguinal/iliohypogastric nerve block was superior to ISW, especially in the first two hours after the surgery. The three anesthetic techniques can be safely and effectively used to control postoperative pain in inguinal herniorrhaphy in children.

JUSTIFICATIVA Y OBJETIVOS: El dolor postoperatorio acarrea un aumento en los gastos y genera una insatisfacción de los padres en relación a la prescripción analgésica para sus hijos. La ropivacaína presenta un amplio margen de seguridad en anestesia regional en pediatría. El objetivo de este estudio fue el de comparar la anestesia peridural sacra (PS) con el bloqueo de los nervios ileoinguinal/ileohipogástrico (BIHII) y con la infiltración de la herida operatoria (IFO) utilizando la ropivacaína para la analgesia postoperatoria en niños. MÉTODO: Se estudiaron 87 niños del sexo masculino, con edad entre 1 y 5 años, sometidos a herniorrafias inguinales electivas unilaterales. Los niños recibieron aleatoriamente la PS, el BIHII o la IFO. Se investigó la necesidad de analgésico en el postoperatorio, el tiempo necesario para su primera dosis, la intensidad de dolor y el grado de bloqueo motor. RESULTADOS: En el grupo de la IFO se observó una mayor necesidad de analgésicos, y una mayor intensidad de dolor en las 1ª y 2ª horas, cuando se comparó con la PS y el BIHII. Apenas niños sometidos a PS presentaron bloqueo motor de grado moderado. El tiempo promedio de la necesidad de la primera dosis de analgésico fue similar entre los grupos. CONCLUSIONES: El BIHII presentó una superioridad sobre la IFO, especialmente en las primeras dos horas del postoperatorio. As tres técnicas anestésicas pueden ser utilizadas con seguridad y eficacia en el control de dolor postoperatorio de herniorrafia inguinal en niños.

[Comparison among three techniques of postoperative regional analgesia with ropivacaine in children.]. / Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína.

BACKGROUND AND OBJECTIVES: Postoperative pain increases cost and generates dissatisfaction among parents regarding to the analgesics prescribed to their children. Ropivacaine has a broad safety margin to be used for regional block in pediatric patients. The aim of this study was to compare caudal epidural block (CE) with ilioinguinal/iliohypogastric nerve block (IINB) and infiltration of surgical wound (ISW) with ropivacaine for postoperative analgesia in children. METHODS: Eighty-seven children, all males, ages 1 to 5, who underwent elective unilateral inguinal herniorrhaphy participated in this study. Children were randomly assigned to receive CE, IINB, or ISW. The need for postoperative analgesia, length of time until the first dose, severity of pain, and degree of the motor blockade were evaluated. RESULTS: The need for analgesia and pain severity in the first two hours were greater for the ISW Group when compared with the CE and IINB Groups. Only the children in the CE Group presented a mild motor blockade. The mean length of time until de 1st dose of analgesic was similar in all groups. CONCLUSIONS: Ilioinguinal/iliohypogastric nerve block was superior to ISW, especially in the first two hours after the surgery. The three anesthetic techniques can be safely and effectively used to control postoperative pain in inguinal herniorrhaphy in children.