The high osteotomy cut of Dega procedure for developmental dysplasia of the hip in children under 6 years of age.

BACKGROUND: Dega osteotomy has gained popularity for the acetabular reconstruction of developmental dysplasia of the hip (DDH). A high-level Dega osteotomy combining the typical Dega procedure with an age limit of under 6 years and the higher pelvic cut height of the Salter osteotomy for walking DDH patients aged 6 or younger was advocated in our department. The purpose of this retrospective study is to introduce this modified Dega procedure and report the preliminary clinical and radiological results in DDH patients under 6. MATERIALS AND METHODS: From September 2000 to September 2010, a total of 162 patients with 191 dysplastic hips between 1.5 and 6 years old were managed with this high-level Dega osteotomy. From each patient's record, clinical status was retrospectively assessed using modified McKay criteria; radiological evaluations were assessed according to the modified Severin classification, the mean acetabular index (AI), Sharp angle and center-edge (CE) angle. Any occurrence of complications was recorded postoperatively. RESULTS: The average age at surgery was 3.6 years (range 1.5 to 6.0), mean duration of follow-up 11.3 years (range 5.0 to 16.9). The latest follow-up fineness (favorable and good) rate in clinical and radiological evaluations was 92.7 % and 91.1 % respectively. There was a marked trend toward normalization of radiographic indices during the follow-up period: the mean AI changed from 38.0° to 20.8°, the mean Sharp's angle decreased from 59.9° to 39.2°, and the mean CE angle increased from -10.7° to 29.4°, preoperatively and at the latest follow-up respectively. No major complications were recorded during follow-up. CONCLUSION: The high osteotomy cut Dega procedure for patients between 1.5 and 6 years of age was found to be sufficient for improving clinical and radiographic outcomes and inducing little morbidity and few complications for late-detected pediatric walking DDH patients.

Interactive tele-education applied to a distant clinical microbiology specialization university course.

The microbiology laboratory provides a strategic support for infectious disease diagnosis and also alerts the medical community about bacterial resistance to antibiotics. The microbiologists' training is a challenge in Brazil, a country with an extensive territory, a diverse population, and disparity of resource allocation. The aim of this study was to implement an interactive tele-educational course in clinical microbiology to reach distant laboratory workers and to improve their professional skills. The course scientific content was defined according to competences associated, distributed in 560 h, with laboratory practices (knowledge matrix-contextual education). The 11-module course structure comprised 70% distance learning, 22% on campus (integrated modules), and 8% monographs. The group included 7 physicians and 21 microbiologists from 20 different Brazilian cities. The time flexibility and location were the two main reasons for student participation, thus decreasing absences to the workplace, different from the traditional teaching methodologies. The group performance was measured by monthly evaluations, and 1 year postcourse, the researcher visited their workplace. There was significant improvement in microbiological practices performed before compared with after group participation. Therefore, 76.9% of laboratory practices were modified because of the knowledge acquired in the course. Students showed behavioral changes in relation to performance in infection control as well as on the dissemination of their knowledge. This specialization course using distance education did not compromise the quality. This educational methodology represents an alternative to teach clinical microbiology to laboratory workers from remote hospitals, as a nationwide continuing educational strategy.

Ações de teleducação interativa em saúde vocal baseadas na dinâmicado projeto jovem doutor / Activities of interactive teleducation in vocal health based on the young doctor dynamics

Introdução: as ações de promoção da saúde vocal devem atingir a população infantil, adulta e idosa, diante dos riscos que todos apresentam em desenvolver disfonia. Neste sentido, o Projeto Jovem Doutor propõe dinâmicas de capacitação para que adolescentes se tornem aptos a disseminar conhecimentos a respeito de temas em saúde para a comunidade. Objetivo: construir e avaliar o conteúdo de um Cybertutor, compondo um programa de capacitação sobre saúde vocal, seguindo a proposta do Projeto Jovem Doutor. Métodos: O Cybertutor de saúde vocal foi elaborado a partir da literatura científica. Posteriormente avaliado pelo Índice de Facilidade de Leitura de Flesch (IFLF) e por 14 alunos do ensinomédio de duas escolas. Esses alunos participaram do programa de capacitação, que consistiu de duas aulas presenciais, acesso ao cybertutor e oficina. Resultados: Os módulos obtiveram média geral de56,68% (dp±8,15) do IFLF caracterizado como nível Padrão. Quanto à avaliação subjetiva, 89,61% dos alunos classificaram a qualidade do cybertutor como excelente/satisfatório, sendo que os itens qualidadedas figuras e organização do conteúdo foram classifi cados como excelente/satisfatório em 100% da amostra. Completadas as atividades, os alunos receberam um jaleco e certificado, intitulando-os de Jovens Doutores, havendo disseminado o conhecimento adquirido para 1300 pessoas da comunidade. Conclusão: a construção e avaliação do cybertutor em saúde vocal expressou a linguagem no nível Padrão e alta satisfação dos alunos. O programa possibilitou a transmissão das informações sobre saúde vocal a um número expressivo de pessoas da comunidade pela ação intensa dos ?Jovens Doutores?...

Introduction: activities of vocal health promotion must reach the young, adult and elderly populations due to risks that everyone presents in the development of Dysphonia. In this purpose, the Young DoctorProject proposes dynamics of training to turn adolescents capable of disseminating, to the community, knowledge about health themes. Objective: to create and evaluate the content of a Cybertutor, composinga training program about vocal health, following the Young Doctor proposal. Methods: the cybertutor on vocal health was developed from the scientific literature. Subsequently, was evaluated by the Flesch Reading Facility Index (FRFI) and by 14 students of high school of two different schools. Those students participated of a training program, consisting in two classroom lectures, cybertutor access and workshop. Results: the modules obtained overall average of 56.68% (sd±8,15) of the FRFI featured as Standard level. Concerning the subjective assessment, 89.61% of students classifi ed the cybertutor quality as excellent/satisfactory, regarding that the items ?figures quality? and ?content organization? were classified as excellent/satisfactory in 100% of sample. In the end of the activities, the students received a white coat and a certificate were, named Young Doctors, disseminating the acquired knowledge to 1300 community people. Conclusion: the creation and evaluation of the cybertutor on vocal health expressed language in the Standard level and high satisfaction of students. The program enabled the communication of information about vocal health to an expressive number of community people by the intense action of the ?Young Doctors?...

Introducción: las acciones de promoción de la salud vocal deben ser llevadas a la población infantil, adulta y anciana delante de los riesgos que todos presentan para desarrolar disfonía. En este sentido, el Proyecto Joven Doctor propone dinámicas de capacitación para que adolescentes se vuelvan aptos para difundir el conocimiento sobre temas de salud para la comunidad. Objetivo: construir y evaluar el contenido de un Cybertutor, componiendo un programa de capacitación sobre la salud vocal, siguiendola propuesta del Proyecto Joven Doctor. Métodos: el Cybertutor de la salud vocal fue elaborado a partir de la literatura científica. Posteriormente evaluado por el Índice de Facilidad de Lectura Flesch (IFLF) y por 14 estudiantes de enseñanza media de dos escuelas. Estos estudiantes participaron del programa de capacitación que fue compuesto por dos clases, acceso al Cybertutor y un taller. Resultados: Los módulos obtuvieron media general de 56,68% (dp±8,15) del IFLF caracterizado como nivel Patrón. En la evaluación subjetiva, 89,61% de los estudiantes calificaron la calidad del Cybertutor como excelente/ satisfactorio, y la calidad de las figuras y organización del contenido se clasifican como excelente/ satisfactorio en 100% de la muestra. Terminadas las actividades, los estudiantes recibieron un guardapolvo y certificado, dándole el título Jóvenes Doctores, que difundieron los conocimientos adquiridos para 1300 personas de la comunidad. Conclusión: La construcción y evaluación del Cybertutor en la salud vocal expreso el lenguaje en el nivel Patrón y alta satisfacción de los alumnos. El programa permitió la transmisión de informaciones sobre la salud vocal para un número significativo de personas de la comunidad por la intensa acción de los ?Jóvenes Doctores?...

Web site for training nonmedical health-care workers to identify potentially malignant skin lesions and for teledermatology.

The development of a Web site to enable nonmedical health professionals to screen skin potentially malignant skin lesions is described. A nurse assistant and a dermatologist tested the Web site. An electronic clinical form was developed to allow a nurse assistant to send case reports and photographs for remote diagnosis by a dermatologist. The nurse assistant photographed the lesions of 92 patients who presented some kind of dermatological condition. The images were then sent for evaluation by the dermatologist followed by in person examination by the same physician. The diagnoses, which resulted from the examination in person and, in some cases, the biopsy results, were compared with the diagnostic impressions of the nurse assistant and with the diagnostic hypothesis of the dermatologist at a distance. The lesions were classified as either malignant or nonmalignant. Kappa statistics showed a high association between the suspected malignity and nonmalignity of the lesions between the dermatologist (p = 6.01 x 10(-9)) and the nurse assistant and between the diagnosis at distance and in person (p < 1.0 x 10(-14)). The Web site allowed a nurse assistant to screen for potentially malignant skin lesions and, thus, proved to be appropriate for a large-scale test.