Desenvolvimento de jogos didáticos para o ensino de Bioquímica / Development of educational games for biochemical education

A Pesquisa de Educação em Bioquímica investiga aspectos relacionados ao ensino-aprendizagem, principalmente no ensino superior. Dentre as alternativas às aulas expositivas, os jogos didáticos apresentam-se como recursos que promovem a elaboração de estratégias, a tomada de decisão, o intercâmbio de informações entre os pares, etc. Estas características configuram os jogos didáticos como ferramentas importantes para a aprendizagem ativa. O objetivo deste trabalho foi desenvolver jogos didáticos para o ensino de bioquímica. Para elaboração dos objetos de ensino, utilizou-se uma estratégia baseada em três etapas: definição das características educativas, elaboração do design conceitual e desenvolvimento do jogo e pré-avaliação. A partir da gravação e transcrição de áudio de algumas partidas dos jogos e, quando possível, por questionários, foram feitas avaliações preliminares a fim de inferir o potencial educacional dos recursos didáticos. Dois jogos didáticos foram desenvolvidos: "Pura Proteína! Uma Experiência no Laboratório de Bioquímica" e "Perfil Lipídico". O objetivo principal do primeiro jogo foi desenvolver competências de planejamento e teste de hipóteses cientificas a partir da simulação de experimentos de purificação de proteínas. A construção deste material foi fundamentada em preceitos teóricos do Ensino por Investigação. Pura Proteína é constituído por um tabuleiro e cerca de 4000 cartas e fichas. Os jogadores, ao início do jogo, recebem um desafio: obter uma determinada quantidade de uma proteína específica, purificada a partir de uma solução composta por uma mistura de proteínas. Para a consecução desse objetivo os estudantes recebem informações sobre alguns métodos de purificação de proteínas mais utilizados. Para vencer, os participantes devem combinar métodos de forma eficaz a obter, antes dos outros jogadores, a quantidade de proteína pura desejada. O jogo foi aplicado com estudantes de graduação em Biomedicina e foi feita uma análisedo processo investigativo que empregavam. Verificou-se que o jogo foi capaz de promover a elaboração de um plano de trabalho, tomada de decisão a partir de argumentações, teste e verificação de hipóteses, ao mesmo tempo em que promovia a diversão. O segundo jogo desenvolvido foi "Perfil Lipídico", por meio do qual pretendeu-se explorar a diversidade das estruturas de lipídeos e os grupos químicos que os compunham. O jogo dispõe de quinze lipídeos, distribuídos em ácidos graxos e lipídeos complexos e, para vencer, os jogadores devem descobrir a identidade de um lipídeo a partir de dicas e desenhar sua estrutura. A prática do jogo permitiu diagnosticar pequenos erros conceituais dos jogadores, revelados ao desenhar as estruturas. Ao responder um questionário, os participantes atestaram que este jogo era motivador, de fácil aplicação em sala de aula e que permitiu revisar a estrutura dos lipídeos. Os dois jogos, com objetivos educacionais muito diferentes, foram desenvolvidos a partir de uma estratégia rigorosa, que permitiu o equilíbrio entre as funções lúdicas e educativas, necessário para o sucesso desta estratégia em sala de aula. Em razão da pandemia da COVID-19, os jogos não puderam ser aplicados com o público apropriado, o que impediu uma avaliação mais robusta do potencial educacional. Os dados coletados, no entanto, forneceram indícios de que ambos os objetos de ensino são eficazes para promover o aprendizado de bioquímica, ao mesmo tempo que a diversão própria do jogo

Biochemical Education research focuses on aspects related to teaching and learning, mostly in higher education. Among several methodological alternatives to traditional classes, educational games are tools that promote the development of problem-solving strategies, decision-making, peer exchange of information, etc. These features make educational games valuable tools for active learning. The main goal of the work herein presented was to develop educational games for Biochemical Education. For this purpose, a three-step based strategy was designed: definition of educational features, conceptual game design and development and evaluation. To assess educational potential, qualitative data were obtained by recording and transcribing audio captured during plays, and, when possible, questionnaires were applied. Two educational games were developed: "Pure Protein! An Experiment in the Biochemistry Lab" and "Ten Questions - Lipids". The main learning purpose of the first game was to develop skills in planning and testing scientific hypotheses through a simulation of a protein purification experiment. The game development was based on an Inquirybased learning approach. Pure Protein is a board game set-up with ca. 4000 cards. Players are challenged to obtain an amount of a specific protein, purified from a protein solution. To achieve this goal, students receive general information about common methods used to purify proteins. To win, contestants should efficiently combine methods to obtain the needed protein before their adversaries. The game was applied to Biomedicine undergraduate students, and an analysis of the inquiry process they went through was done. It was verified that the game promotes elaboration of a working plan, decision-making supported by arguments, testing and verifying hypotheses while being a fun and enjoyable activity. The second game is called "Ten Questions - Lipids", by which we intended to explore the structural diversity of lipids and the chemical groups in their composition. The game is based on fifteen molecules, ranging from fattyacids to complex lipids. The goal is to figure out the identity and the structure of a given lipid, using clues given throughout the gameplay. The game application allowed us to assess players conceptual mistakes revealed by their drawings of chemical structures. In questionnaire answers, students stated that the game was motivating, suitable for the classroom and that it promoted the review of lipid structures. Both games, with different learning objectives, were developed using a rigorous strategy, which enables the balance between the ludic and educational functions needed to achieve educational game success. Due to the COVID-19 pandemic, the games werent properly evaluated with different, larger groups. Nevertheless, the collected data suggest that the teaching objects are efficient both in promoting biochemical learning and fun

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in.

OBJECTIVES: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. METHOD: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. RESULTS: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. CONCLUSIONS: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in / Validación de Instrumento para fundamentar dimensionamiento de Profesionales de Enfermería em Alojamiento Conjunto / Validação de Instrumento para fundamentar dimensionamento de Profissionais de Enfermagem em Alojamento Conjunto

ABSTRACT Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

RESUMEN Objetivos: elaborar y validar un instrumento para clasificación de binomios puerperio neonatal que subsidie el dimensionamiento de personal en unidades de alojamiento conjunto. Métodos: estudio metodológico. La construcción ha sido basada en referencias teóricas y legales. La validez de contenido ha sido realizada por expertos por medio de medición del índice de validez de contenido. Luego, el instrumento ha sido aplicado en una muestra de 122 binomios, y ha sido realizado análisis factorial exploratoria por el método de componentes principales. Resultados: el instrumento ha quedó constituido por siete indicadores de cuidado: Vía de parto; Morbilidad materna; Morbilidad neonatal; Amamantamiento; Agravantes sociales; Orientación de cuidados; e Interacción y vínculo. Todos con índice de validez de contenido iguales a 1. El constructo ha sido compuesto por 3 dominios, con Alfa de Cronbach de 0,62, 0,85 y 0,89. Conclusiones: el instrumento para la clasificación de binomios puerperio neonatal permite la clasificación de binomios puerperio neonatal y podrá basarse el dimensionamiento de personal en alojamiento conjunto.

RESUMO Objetivos: construir e validar um instrumento para classificação de binômios puérpera-neonato que subsidie o dimensionamento de pessoal em unidades de alojamento conjunto. Métodos: estudo metodológico. A construção foi embasada em referenciais teóricos e legais. A validade de conteúdo foi realizada por expertos por meio de mensuração do índice de validade de conteúdo. Em seguida, o instrumento foi aplicado em uma amostra de 122 binômios, e foi realizada análise fatorial exploratória pelo método de componentes principais. Resultados: o instrumento ficou constituído por sete indicadores de cuidado: Via de parto; Morbidade materna; Morbidade neonatal; Aleitamento; Agravantes sociais; Orientação de cuidados; e Interação e vínculo. Todos com índice de validade de conteúdo iguais a 1. O constructo foi composto por 3 domínios, com Alfa de Cronbach de 0,62, 0,85 e 0,89. Conclusões: o instrumento para a classificação de binômios puérpera-neonato permite a classificação de binômios puérpera-neonato e poderá embasar o dimensionamento de pessoal em alojamento conjunto.

ICU staffing feature phenotypes and their relationship with patients' outcomes: an unsupervised machine learning analysis.

PURPOSE: To study whether ICU staffing features are associated with improved hospital mortality, ICU length of stay (LOS) and duration of mechanical ventilation (MV) using cluster analysis directed by machine learning. METHODS: The following variables were included in the analysis: average bed to nurse, physiotherapist and physician ratios, presence of 24/7 board-certified intensivists and dedicated pharmacists in the ICU, and nurse and physiotherapist autonomy scores. Clusters were defined using the partition around medoids method. We assessed the association between clusters and hospital mortality using logistic regression and with ICU LOS and MV duration using competing risk regression. RESULTS: Analysis included data from 129,680 patients admitted to 93 ICUs (2014-2015). Three clusters were identified. The features distinguishing between the clusters were: the presence of board-certified intensivists in the ICU 24/7 (present in Cluster 3), dedicated pharmacists (present in Clusters 2 and 3) and the extent of nurse autonomy (which increased from Clusters 1 to 3). The patients in Cluster 3 exhibited the best outcomes, with lower adjusted hospital mortality [odds ratio 0.92 (95% confidence interval (CI), 0.87-0.98)], shorter ICU LOS [subhazard ratio (SHR) for patients surviving to ICU discharge 1.24 (95% CI 1.22-1.26)] and shorter durations of MV [SHR for undergoing extubation 1.61(95% CI 1.54-1.69)]. Cluster 1 had the worst outcomes. CONCLUSION: Patients treated in ICUs combining 24/7 expert intensivist coverage, a dedicated pharmacist and nurses with greater autonomy had the best outcomes. All of these features represent achievable targets that should be considered by policy makers with an interest in promoting equal and optimal ICU care.

Work schedule characteristics and fatigue among rotating shift nurses in hospital setting: An integrative review.

AIM: To systematically evaluate the effect of work schedule characteristics on fatigue among shift nurses in hospital settings. BACKGROUND: The complexity and multidimensional nature of nursing work may lead to fatigue. This review mainly focused on work schedule characteristics that may mitigate the fatigue in nurses. EVALUATION: Six databases were searched, and eight relevant research articles published between 2000 and 2018 were identified. KEY ISSUES: The reviewed articles provided evidence supporting the association of work schedule characteristics such as total working hours, overtime, shift length and number of monthly night and evening shifts with fatigue. In addition, studies provided evidence for the positive association between insufficient rest period between shifts and fatigue among shift nurses in hospital settings. CONCLUSION: The reviewed studies provided mixed results regarding the associations between work schedule characteristics and nurse fatigue. However, quick returns and days called to work on days off were consistent factors contributing to nurse fatigue. More evidence is needed to arrive at a definitive conclusion about such relationships. IMPLICATION FOR NURSING MANAGEMENT: Nursing managers and administrators need to carefully review current rotating shift system and examine its impact on nurse fatigue as well as ensure enough resting time when developing nurse schedules.

Changes in public health workforce composition: proportion of part-time workforce and its correlates, 2008-2013.

BACKGROUND: State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. PURPOSE: To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. METHODS: We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. RESULTS: Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. CONCLUSIONS: This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing.

Airmen with mild traumatic brain injury (mTBI) at increased risk for subsequent mishaps.

BACKGROUND: Little is known regarding long-term performance decrements associated with mild Traumatic Brain Injury (mTBI). The goal of this study was to determine if individuals with an mTBI may be at increased risk for subsequent mishaps. METHODS: Cox proportional hazards modeling was utilized to calculate hazard ratios for 518,958 active duty U.S. Air Force service members (Airmen) while controlling for varying lengths of follow-up and potentially confounding variables. Two non-mTBI comparison groups were used; the second being a subset of the original, both without head injuries two years prior to study entrance. RESULTS: Hazard ratios indicate that the causes of increased risk associated with mTBI do not resolve quickly. Additionally, outpatient mTBI injuries do not differ from other outpatient bodily injuries in terms of subsequent injury risk. CONCLUSIONS: These findings suggest that increased risk for subsequent mishaps are likely due to differences shared among individuals with any type of injury, including risk-taking behaviors, occupations, and differential participation in sports activities. Therefore, individuals who sustain an mTBI or injury have a long-term risk of additional mishaps. PRACTICAL APPLICATIONS: Differences shared among those who seek medical care for injuries may include risk-taking behaviors (Cherpitel, 1999; Turner & McClure, 2004; Turner, McClure, & Pirozzo, 2004), occupations, and differential participation in sports activities, among others. Individuals with an mTBI should be educated that they are at risk for subsequent injury. Historical data supported no lingering effects of mTBI, but more recent data suggest longer lasting effects. This study further adds that one of the longer term sequelae of mTBI may be an increased risk for subsequent mishap.

Going beyond patient classification systems to create an evidence-based staffing methodology.

The Department of Veterans Affairs developed a nationally standardized nurse staffing methodology, using an evidence-based process. We present an overview, linking an integrative review of recent literature on patient classification systems, interdisciplinary expert panel consultation, operational feasibility assessment, and frontline manager involvement. This resulted in 7 candidate indicators for inclusion in unit-specific staffing models. Adaptable to all healthcare settings, this process goes beyond traditional patient classification systems.

Emergency Department Workforce Models: What the literature can tell us.

The present study looks at what the literature can tell us about examples of innovative ED staffing. Numerous medical databases, journals specific to emergency care, and key government agency sites were searched to obtain Australian and relevant international literature between 1995 and the present. Studies which discussed appropriate staffing arrangements in the EDs were assessed with preference given to those which gathered evidence about the staff mix. There is little literature available which looks at the entire staffing profile of an ED and assesses its effectiveness. The few papers that do exist conclude that senior staffing, matching peak staffing levels with peak patient demand, having appropriately skilled staff mixes and designing the staff profile based upon individual hospital needs produces the most effective outcomes. Although there are some lessons to be learnt from the success of the staffing of various teams, and the introduction of new roles in the EDs, there are still significant gaps within the literature. There is a need for assessment of the effectiveness of various ED-wide staffing profiles (rather than just individual teams within an ED).

Commentary: Missing the elephant in my office: recommendations for part-time careers in academic medicine.

Several recent articles in this journal, including the article by Linzer and colleagues in this issue, discuss and promote the concept of part-time careers in academic medicine as a solution to the need to achieve a work-life balance and to address the changing demographics of academic medicine. The article by Linzer and colleagues presents the consensus of a task force that attempted to address practical considerations for part-time work in academic internal medicine. Missing from these discussions, however, are a consensus on the definition of part-time work, consideration of how such strategies would be available to single parents, how time or resources will be allocated to part-time faculty to participate in professional associations, develop professional networks, and maintain currency in their field, and how part-time work can allow for the development of expertise in research and scholarly activity. Most important, the discussions about the part-time solution do not address the root cause of dissatisfaction and attrition: the ever-increasing and unsustainable workload of full-time faculty. The realization that an academic full-time career requires a commitment of 80 hours per week begs the question of whether part-time faculty would agree to work 40 hours a week for part-time pay. The historical underpinnings of the current situation, the implications of part-time solutions for the academy, and the consequences of choosing part-time work as the primary solution are discussed. Alternative strategies for addressing some of the problems facing full-time faculty are proposed.

Part-time careers in academic internal medicine: a report from the association of specialty professors part-time careers task force on behalf of the alliance for academic internal medicine.

To establish guidelines for more effectively incorporating part-time faculty into departments of internal medicine, a task force was convened in early 2007 by the Association of Specialty Professors. The task force used informal surveys, current literature, and consensus building among members of the Alliance for Academic Internal Medicine to produce a consensus statement and a series of recommendations. The task force agreed that part-time faculty could enrich a department of medicine, enhance workforce flexibility, and provide high-quality research, patient care, and education in a cost-effective manner. The task force provided a series of detailed steps for operationalizing part-time practice; to do so, key issues were addressed, such as fixed costs, malpractice insurance, space, cross-coverage, mentoring, career development, productivity targets, and flexible scheduling. Recommendations included (1) increasing respect for work-family balance, (2) allowing flexible time as well as part-time employment, (3) directly addressing negative perceptions about part-time faculty, (4) developing policies to allow flexibility in academic advancement, (5) considering part-time faculty as candidates for leadership positions, (6) encouraging granting agencies, including the National Institutes of Health and Veterans Administration, to consider part-time faculty as eligible for research career development awards, and (7) supporting future research in "best practices" for incorporating part-time faculty into academic departments of medicine.

Is networking different with doctors working part-time? Differences in social networks of part-time and full-time doctors.

BACKGROUND: Part-time working is a growing phenomenon in medicine, which is expected to influence informal networks at work differently compared to full-time working. The opportunity to meet and build up social capital at work has offered a basis for theoretical arguments. METHODS: Twenty-eight teams of medical specialists in the Netherlands, including 226 individuals participated in this study. Interviews with team representatives and individual questionnaires were used. Data were gathered on three types of networks: relationships of consulting, communication and trust. For analyses, network and multilevel applications were used. Differences between individual doctors and between teams were both analysed, taking the dependency structure of the data into account, because networks of individual doctors are not independent. Teams were divided into teams with and without doctors working part-time. RESULTS AND DISCUSSION: Contrary to expectations we found no impact of part-time working on the size of personal networks, neither at the individual nor at the team level. The same was found regarding efficient reachability. Whereas we expected part-time doctors to choose their relations as efficiently as possible, we even found the opposite in intended relationships of trust, implying that efficiency in reaching each other was higher for full-time doctors. But we found as expected that in mixed teams with part-time doctors the frequency of regular communication was less compared to full-time teams. Furthermore, as expected the strength of the intended relationships of trust of part-time and full-time doctors was equally high. CONCLUSION: From these findings we can conclude that part-time doctors are not aiming at efficiency by limiting the size of networks or by efficient reachability, because they want to contact their colleagues directly in order to prevent from communication errors. On the other hand, together with the growth of teams, we found this strategy, focussed on reaching all colleagues, was diminishing. And our data confirmed that formalisation was increasing together with the growth of teams.

[Patient classification systems. Nursing workload from the perspective of applied research (part 2)]. / Patientenklassifikationssysteme. Leistungsdaten im Blickfeld angewandter Forschung (Teil 2).

Building on the first part of the article, which described aims, forms and a new developed typology of Patient Classification Systems (PCS), the second part discusses three wrong assumptions that are often behind the application of common PCS. These assumptions deal mainly with indices of nursing care intensity for measuring of staff requirements and with patient characteristics (deficiencies and problems) in regard to the expenditure of time. Additional examinations show whether or not it is scientifically possible to express staff requirements on the basis of added up individual nursing activities. Data collected in several intensive care units by diagnosis related analysis of work activities (DTA) show that the distribution of expenditure of time for singular nursing activities does not result in meaningful arithmetic means usable for assessment instruments scheduling of personnel. Given these methodical constraints it should be examined with minuteness before the application of a PCS exactly which question should be answered by an instrument or method, and it should be examined whether the method is suitable for the question asked.

Study of shift work and risk of coronary events.

BACKGROUND: The effects of shift work on coronary heart diseases (CHD) are well described. Most of the studies on coronary events in shift workers are supportive of the hypothesis that they are at increased risk. OBJECTIVE: The objective of this study was to investigate the relation shift work has to risk of CHD in a cohort of men from different Asian races working in a fertilizer plant in the Middle East. DESIGN: This is a case series of cohort study. SUBJECTS: The medical records for 2562 staff employed at the plant, from the start of the company in 1972 till 2003, were surveyed. Of these, 648 were shift workers and 1914 were daytime workers. A total of 223 employees had cardiovascular event. METHODS: For each case we recorded the date and age at start of employment, and the age at the time of diagnosis. Data from their last medical examination in the company were used to calculate their BMI, and to register whether they were smokers, had diabetes, or were senior or intermediate staff. Univariate and multivariate statistical analyses were performed. RESULTS: The incidence of CHD is significantly higher in shift workers (13.5%) compared with the daytime workers (7.1%). Also, there was a statistically significant difference between shift workers and daytime workers concerning hypertension and cerebrovascular incidents. CONCLUSION: Our results suggest the possibility of an overall relationship between shift work and cardiovascular diseases.

Sleep, sleepiness and health complaints in police officers: the effects of a flexible shift system.

The aim of the study was to study the effects of a flexible shift system (based on self-determined work hours) with respect to sleep/wake complaints and subjective health. The comparison group was a rapidly rotating shift system, with frequently occurring quick returns. A secondary aim was to examine the relation between work hour characteristics indicating compressed or difficult rosters (e.g. number of workdays in a row, frequency of quick returns and long work shifts) and subjective sleep and sleepiness, within the flexible shift system group. The sample of the analysis included 533 randomly selected police officers, of which 26% were females. The participants answered a questionnaire. The results showed that the flexible shift system group did not differ with respect to sleep/wake complaints and subjective health. However, the flexible shift group obtained more sleep in connection with the shifts, probably because of longer rest time between shifts. Thus, they worked less quick returns and long work shifts. The association between work hour characteristics and sleep/wake complaints was weak in the flexible shift group. Instead, sleep/wake problems were mainly associated with the attitude to work hours.

[Patient classification systems. Nursing workload from the perspective of applied research (part I)]. / Patientenklassifikationssysteme. Leistungsdaten im Blickfeld angewandter Forschung (Teil 1).

This article describes in two parts the basic principles of categorising nursing data into Patient Classification Systems (PCS) and related findings of nursing research. PCS are used to group patients into classes by using some specified criteria or indicators, e.g. needs of a patient, functional status or different nursing activities. They are often applied to constitute staff requirements. Since the large number of available classification systems differs in terms of development procedures and use of resulting data, it was rarely possible to compare different PCS with each other until now. Therefore a typology of PCS was developed, which is presented in the first part of this article. While assigning current PCS to adequate classes of the typology, the development and complexity of different PCS can be evaluated and discussed. Thus using the typology allows to identify advantages and limitations of individual classification systems. Conclusions can be drawn about requirements for further PCS development.

Full-time or part-time work in nursing: preferences, tradeoffs and choices.

Nursing human resources are limited; thus, effective deployment of personnel is essential to optimize staff capacity. The nursing profession competes for staff in environments where human capital is at a premium. To maximize recruitment and retention, it is imperative that nurses' work preferences be taken into account.