An immersive simulation strategy to teach canine vaginal cytology: A multi-centre study.

Vaginal cytology (VC) is an essential technique for monitoring the bitch's estrus cycle. Currently, animal-free teaching methodologies have not been investigated for VC. Hence, this study aimed to evaluate an immersive simulation with a VC model and augmented reality tools. Students (n = 219) from four universities were enrolled, having learning stations with models for practising VC that provided immediate feedback on the technique. Augmented reality tools comprised QR codes that endorsed students to short videos of owners' avatars reporting the clinical reproductive story of the simulated animals and slides with QR codes leading to microscopy slide navigation videos. Proestrus, estrus, diestrus, anestrus and vaginitis were identified in the learning stations. The students' perceptions were evaluated through questionnaires assessing satisfaction, motivation, confidence, impact on learning and diagnostic accuracy. Before the immersive simulation, students had no experience with VC, being afraid of doing a VC with a live dog. Almost all the students considered practicing VC as essential and 94% reported that repeating the procedure (>2 times) was the most important parameter for learning. The simulation activity lasted ≈3 h and significantly improved the confidence of students, being less afraid of doing a VC in a live animal. Slide navigation videos improved the diagnostic accuracy of the estrus cycle stage, and students diagnosed the estrus and vaginitis cases more accurately. The immersive simulation strategy allowed repeated practice in a safe, motivated and standardized environment, being appraised by students as an essential strategy for learning VC.

Development and Validation of a Simulation Model for Collection of Canine Vaginal Samples.

Vaginal cytology is a widely used cytological technique mostly taught by observation, either through direct tutoring or videos. To the best of our knowledge, vaginal cytology simulators have never been assessed in veterinary medicine. Twenty-five undergraduate students with no prior experience in canine vaginal sampling were randomly assigned to two groups that either practiced the procedure in a simulator or a live animal. An inverted classroom design was followed. After observing a video tutorial, students practiced with the simulator/live animal for two classes. Three weeks later, they performed a vaginal cytology on a live animal being recorded. The videos were evaluated through an objective structured clinical examination (OSCE) by an observer blinded to the student's groups. The learning outcome was compared through OSCE pass rates and questionnaires. The simulation model was made by 3D printing and soft silicone for the vulvar labia, having pink and blue colored vaseline in the correct and incorrect locations for sampling. The model was economic and accurately replicated the female reproductive tract. It provided immediate feedback to students, by obtaining pink or blue swabs from the correct and incorrect locations, respectively. Students reported that three to five or more attempts were needed to properly learn the procedure, thus justifying the need for a simulator. No differences in the OSCE pass rates were observed between the groups. The simulation model was effective for learning the vaginal cytology procedure, replacing the use of live animals. This low-cost model should be incorporated in the tool-kit of reproduction classes.

The Use of Simulation Models and Student-Owned Animals for Teaching Clinical Examination Procedures in Veterinary Medicine.

Clinical examination procedures (CEPs) are cornerstone clinical skills for veterinary practitioners, being taught in all veterinary faculties. CEPs include innocuous procedures that are well tolerated by animals as well as more distressful and less tolerated ones. In a classical approach, institutional animals are used to teach and practice CEPs. Two hundred and thirty-one undergraduate students from four consecutive years were assigned to two groups that used institutional animals only (AO) or a combination of students' owned animals and simulation models (model-animal, MA) to teach and practice CEPs. This latter comprised stuffed teddy dogs, eye and ear models made of molding silicone, as well as skin models. The learning outcome of each system was compared through questionnaires (throughout classes and at the end of course), grades, and pass rates in objectively structured clinical examinations. Most veterinary students had their own animals, being easy to have a dog per group of two students in class. All the students' owned animals adapted well to this environment. The interest in the practical activities with the simulation models was comparable to that exhibited in the classical AO system. Students reported to learn more with the MA system than with the AO, while the interest on the subjects and the relevance were appraised similarly in both systems. No differences existed in the final grades and pass rates. The MA system was effective for learning CEPs. Beyond animal welfare advantages, this system increased the out-of-school training and had financial saving benefits, being a valuable option for the teaching and training of CEPs.

Problemas na cultura de segurança do paciente em uma unidade de pronto atendimento: análise causal / Problemas en la cultura de seguridad del paciente en una unidad de emergencia: análisis de la cadena causal / Problems in the patient safety culture in an emergency care unit: causal analysis

Objetivo: construir uma matriz de análise para identificação dos problemas relacionados à cultura de segurança do paciente em uma unidade de pronto atendimento no sul do Brasil. Método: a primeira etapa, com delineamento transversal descritivo, ocorreu de julho a agosto de 2018, com enfermeiros, por meio da autoaplicação do instrumento "Safety Attitudes Questionaire - SAQ Short Form 2006". Na segunda etapa, com delineamento exploratório descritivo, as questões do SAQ passaram por análise interpretativa, realizada por enfermeiras dedicadas ao estudo da temática, em abril de 2021. Resultados: os problemas na cultura de segurança do paciente na unidade de pronto atendimento relacionaram-se à estrutura, processos de gestão e processos clínicos, principalmente de caráter organizacional. Conclusão: a utilização da análise de cadeia causal permitiu a construção de uma matriz de análise, facilitando a identificação dos principais problemas relacionados à cultura de segurança do paciente na unidade de pronto atendimento.

Objetivo: to develop an analysis matrix to identify problems related to the patient safety culture in an emergency care unit in southern Brazil. Método: the first stage, with a descriptive cross-sectional design, occurred from July to August 2018, with nurses, through the self-application of the instrument "Safety Attitudes Questionaire - SAQ Short Form 2006". In the second stage, with a descriptive exploratory design, the SAQ questions underwent an interpretative analysis, carried out by nurses dedicated to the study of the subject, in April 2021. Resultados: the problems in the patient safety culture in the emergency care unit were related to the structure, management processes and clinical processes, mainly of an organizational nature. Conclusión: the use of causal chain analysis allowed the construction of an analysis matrix, facilitating the identification of the main problems related to the patient safety culture in the emergency care unit.

Objective: to evaluate the clinical predictors for dry eye and the nursing diagnosis Risk of dry eye in postoperative patients in the Post-Anesthesia Care Unit. Method: cross-sectional study conducted between May and August, 2017. The sample was 157 adult patients undergoing elective surgical procedures. Data were analyzed using descriptive and inferential statistics. Results: the clinical diagnosis of dry eye prevailed in 85.35% of patients, and the nursing diagnosis Risk of dry eye in 14.65%. Statistical differences were observed between hyperemia, excessive tearing and insufficient Schirmer test with the diagnosis of ocular dryness in the right eye and with the diagnosis Risk of dry eye. In the left eye the Schirmer test was insufficient. Conclusão: hyperemia, excessive tearing and insufficient Schirmer test are relevant perioperative clinical predictors to promote preventive measures and/or early detection of dry eye.

The advantages of using cytospins of uterine lavage fluid for the diagnosis of equine endometritis.

Uterine lavage (UL) is a routine diagnostic procedure for endometritis. In UL the fluid is centrifuged and the sediment smeared. Samples prepared in cytocentrifuges, the so-called "cytospins", are useful for evaluating cells in fluids, but never been used in UL. The aim of this study was to assess the usefulness of cytospins after UL, comparing automatic versus manual cytocentrifuges, and to determine their value for the diagnosis of endometritis. The study was divided in two parts. Firstly, UL was performed in 16 mares and a small part of the retrieved fluid was cytocentrifuged in an automatic (PreCyto) and manual (PreMan) cytocentrifuge, whereas the remaining fluid was centrifuged. After that, the sediment was divided into three quotas. One quota was smeared, one was processed in an automatic cytocentrifuge (PostCyto) and the last quota was cytospinned in a manual apparatus (PostMan). Cytospins obtained were scored for cellularity, cell preservation, presence of inflammatory cells, bacteria and contaminants; results were compared with sediment smears. Secondly in this study, the best cytospin method was compared with sediment smears in another group of 13 mares, which had endometrial biopsy after UL. Agreement between sediment smears and cytospins was poor to moderate. Compared to sediment smears, cytospins were more cellular, with better morphological details. Urine crystals and fecal contamination were detected more often in cytospins (especially PostCyto and PostMan). No differences in the percentage of inflammatory or epithelial cells existed. PostMan was considered the best method to evaluate UL fluid and it had higher sensitivity (80%), compared with sediment smears (60%), for diagnosing endometritis. Cytocentrifugation offers significant advantages over sediment smears and the manual cytocentrifuge is well suited for horse stable conditions.

Desenvolvimento organizacional da atenção primária à saúde: estratégias para o fortalecimento da segurança do paciente / Organizational development of primary health care: strategies for strengthening patient safety

Resumo: A segurança do paciente é uma dimensão fundamental para a qualidade em saúde, e visa promover a redução dos riscos de danos desnecessários associados à assistência de saúde. Sabe-se que a Atenção Primária à Saúde é a principal porta de entrada das redes de atenção, e muitas vezes, os eventos adversos são iniciados nesse cenário, com isso, nota-se que a cultura de segurança do paciente é vista como ponto de partida para compreender o cenário atual e planejar ações para o aperfeiçoamento do cuidado. Os objetivos desse estudo foram: descrever a cultura de segurança entre os enfermeiros da Atenção Primária à Saúde; Apresentar a cultura de segurança do paciente na perspectiva dos desafios a serem enfrentados na Atenção Primária à Saúde para o desenvolvimento organizacional; e elencar estratégias genéricas e específicas de mudança que fortaleçam a segurança do paciente na Atenção Primária à Saúde. Trata-se de uma pesquisa descritiva, de abordagem quanti-qualitativa. A coleta de dados ocorreu de julho a dezembro de 2017, em 14 unidades de saúde: sete Estratégias Saúde da Família e sete Unidades Básicas de Saúde de um Distrito Sanitário de Saúde em Curitiba - PR. Participaram 52 enfermeiros. O estudo foi dividido em três etapas: descritiva, explicativa e prescritiva. Na etapa descritiva, utilizou-se o instrumento Medical Office Survey on Patient Safety Culture (MOSPSC), composto por 51 perguntas que medem doze dimensões da segurança do paciente. Os dados foram analisados por estatística descritiva, por meio da escala de Likert. Na explicativa, foi feita a análise da cadeia causal para identificação dos principais problemas relacionados à segurança do paciente. E por fim, na etapa prescritiva, efetuou-se a discussão da análise da cadeia causal à luz da teoria do desenvolvimento organizacional para propor ações estratégicas de melhorias para a segurança do paciente. Na sequência, realizou-se a validação de conteúdo das estratégias, por meio, do Índice de Validação de Conteúdo, Frequência absoluta e relativa das avaliações e a Porcentagem de Concordância. Como resultado, observou-se na etapa descritiva que a avaliação global da segurança do paciente nas unidades de saúde foi considerada positiva na percepção dos participantes, como 'bom' para 73,9% dos profissionais das UBS e "muito bom" para 50% da Estratégia Saúde da Família. Os principais problemas elencados na etapa explicativa foram relacionados aos equipamentos, exames, prontuários, quantitativo profissional, à pressa, ao fluxo de trabalho, à gestão do serviço, à quantidade ser mais importante que a qualidade, à troca de informação e aos profissionais que acreditam que os erros podem ser usados contra si. Tendo em vista esses problemas, na etapa prescritiva foram elaboradas estratégias genéricas e específicas para a melhoria da segurança do paciente na Atenção Primária, tais como, priorizar a segurança do usuário acima de metas financeiras e operacionais, incentivar a equipe na APS a notificação do evento adverso, realizar a vigilância, monitoramento e a notificação dos eventos adversos, entre outros. Na validação das estratégias pôde-se analisar que os participantes atestaram a qualidade do conteúdo das estratégias, pois 94,6% dos profissionais concordaram com a viabilidade do instrumento. Concluiu-se que com a elaboração das estratégias de melhoria, pode-se notar que a cultura de segurança no local de estudo apresentou potencialidades e fragilidades que necessitam ser trabalhadas. Deseja-se que as estratégias sugeridas possam fortalecer as equipes de saúde para o desenvolvimento de uma assistência segura, provendo uma cultura de segurança não punitiva.

Abstract: Patient's safety is a key to health quality and aims to reduce the risk of unnecessary harm associated with health care. It's known that Primary Health Care is the main gateway for care networks, and errors, incidents, and adverse events are often initiated in this scenario. Based on that, it is understandable that the culture of security in Primary Health Care is seen as the starting point to understand the current scenario and plan actions to improve patient's safety. The objectives of this study were: describe the safety culture among Primary Health Care nurses; explain the patient's safety culture in the perspective of the challenges that are faced in Primary Health Care for organizational development; and identify generic and specific strategies for changing the strengthen patient's safety in Primary Health Care. It is a descriptive research with a qualitative-quantitative approach. Data collection took place in December 2017, in 14 health units: seven from Family Health Strategies and seven from basic health units in a Health Sanitary District in Curitiba, Brazil. 52 nurses participated. The study was divided into three phases: descriptive, explanatory and prescriptive. During the descriptive phase, the Medical Office Survey on Patient Safety Culture (MOSPSC) instrument was used. It contains 51 questions that measure twelve dimensions of patient safety. The data was analyzed by descriptive statistics, using the Likert scale. In the explanatory phase, a causal chain analysis was performed to identify the main problems related to patient safety. Finally, in the prescriptive stage, a discussion of causal chain was made in light of organizational development to propose strategic actions for improvements in patient safety. The content validation of the strategies was then validated by means of the Content Validation Index, absolute and relative frequency of evaluations and the Percentage of Concordance. As result, it was observed that the overall evaluation of patient safety in health units was considered positive according to the participant's perceptions, 73.9% of the professions of USB answered "good" and for the Family Health Strategies 50% as "very good". The main problems listed in the explanatory phase were related to equipment, exams, patient's medical record, professional quantification, workflow, service management, the quantity being more important than quality, information exchange and professionals who believed that mistakes could be used against them. In view of these problems, in the prescriptive phase, generic and specific strategies were developed to improve patient safety in Primary Health Care, such as prioritizing user safety over financial and operational goals, encouraging the team in APS to notify the adverse events, monitoring and reporting adverse events, among others. In the validation of the strategies it was possible to analyze that the participants attested the quality of the content of the strategies, since 94.6% of the professionals agreed with the viability of the instrument. It concludes with the elaboration of the improvement strategies, it can be recognized that it is a safety culture in the place of study presented the potentialities and fragilities that need to be improved. It is hoped that the suggested strategies can empower the health teams to development of a safe condition, providing a non-punitive safety culture.

Application of a chairside anaerobic culture test for endodontic treatment.

Periapical lesions are caused by bacterial infections. The fundamental objective of endodontic treatment is to eliminate bacteria present in the root canal system because they play an important role in the development and maintenance of periapical lesions. Therefore, confirming the absence of bacteria before filling root canals is important. Anaerobic culture tests have been used in many endodontic cases, and they have brought about good treatment outcomes. These tests, however, require specific apparatuses and bacteriological techniques. Here, we report a chairside anaerobic culture test that does not require any specialized apparatuses or techniques. We also report two endodontic cases in which this simple test was used. Both patients were diagnosed with chronic purulent periapical lesions. After confirming the absence of bacteria in the root canals, they were filled with gutta-percha points. At followup, the radiolucencies showed recovery, although longterm observation is under way. From these results, the authors conclude that this simple chairside anaerobic culture test is effective for evaluating periapical lesion treatment procedures.

Determinaçäo da suscetibilidade a antimicrobianos em cepas do grupo Bacteroides fragilis: situaçäo atual e perspectivas / Antimicrobial susceptibility tests for Bacteroides fragilis group strains: current situation and perspectives

Testes de suscetibilidade a antimicrobianos para 44 cepas do grupo Bacteroides fragilis foram realizafos, com o objtivo de comparar os resultados obtidos através de uma modificaçäo da técnica de Wilkins & Thiel e o método de diluiçäo em ágar recomendado pelo NCCLS. As concentraçöes críticas (breakpoints) para o método de eluiçäo do disco no caldo e o de referência foram: cefoxitina, 18 e 16µg/ml, tetraciclina, 6 e 4µg/ml, e clindamicina, 2 e 8µg/ml, respectivamente. Um percentual de concordância de 77,3 por cento foi obtido para cefoxitina, 75 por cento para clindamicina e 63,6 por cento para tetraciclina. Em relaçäo a cloranfenicol e metronidazol, o percentual de concordância obtido, quando comparados os dois métodos, foi de 100 por cento. Estes dados indicam a falta de correlaçäo entre os dois métodos para tetraciclina, cefaloxitina e clindamicina e sugerem a necessidade de cuidados na interpretaçäo, se o teste avaliado for utilizado. O teste de eluiçäo do disco no caldo näo é mais recomendado pelo NCCLS. Encontrar um teste simples, rápido, econômico, reproduzível e facilmente comercializável para testar a suscetibilidade de bactérias anaeróbias estritas a antimicrobianos, é, atualmente, o desafio da microbiologia dos anaeróbios

Modelo de decontaminación `in vivo' para el aislamiento de leptospiras y modificación de los medios de Korthof y Fletcher / Decontamination pattern `in vivo' for the isolation of leptospira and modification of Korthof and Fletcher media

Se realizó un estudio experimental utilizando 100 ratones Swiss de diferentes edades, en la búsqueda de aquellos cuya edad fuera la adecuada para cumplir la función de `filtro vivo'. Cultivos puros de leptospira se obtuvieron en ratones de dos y tres semanas de edad a partir de sangre obtenida por punción cardiaca a los 10, 20 y 30 minutos de postinoculación intraperitoneal con cultivo contaminado. Se modificó la composición de los medios de cultivo Korthof y Fletcher sustituyendo el suero de conejo al 10 por ciento por suero de carnero al 8-10 por ciento inactivado a 56 grados C por 30 minutos para leptospira biflexa y suero total para Leptospira interrogans. La metodología y modificación descrita en ambos procesos para su bajo costo y simplicidad, pueden ser de gran ayuda para el aislamiento de leptospira patógenas o saprofitas a partir de muestras clínicas contaminadas, suelo y agua en los medios modificados