Translation, transcultural adaptation, and validation of the role-modeling cost-conscious behaviors scale.

BACKGROUND: Training in the use of cost-conscious strategies for medical students may prepare new physicians to deliver health care in a more sustainable way. Recently, a role-modeling cost-conscious behaviors scale (RMCCBS) was developed for assessing students' perceptions of their teachers' attitudes to cost consciousness. We aimed to translate the RMCCBS into Brazilian Portuguese, adapt the scale, transculturally, and validate it. METHODS: We adopted rigorous methodological approaches for translating, transculturally adapting and validating the original scale English version into Brazilian Portuguese. We invited all 400 undergraduate medical students enrolled in the 5th and 6th years of a medical course in Northeast Brazil between January and March 2017 to participate. Of the 400 students, 281 accepted to take part in the study. We analyzed the collected data using the SPSS software version 21 and structural equation modeling (SEM) was performed using AMOS SPSS version 18. We conducted exploratory factor analysis (EFA), varimax rotation, with Kaiser Normalization and Principal Axis Factoring extraction method. We conducted confirmatory factor analysis (CFA), using the SEM. We used the following indexes of adherence of the model: Comparative fit index (CFI), Goodness-of-fit index (GFI) and Tucker-Lewis Index (TLI). We considered the Bayesian Information Criterion (BIC) for Sample-size adjusted. The root mean square error of approximation was calculated. Values below 0.08 were considered acceptable. Composite reliability analyzes were performed to evaluate the accuracy of the instrument. Values above 0.70 were considered satisfactory. RESULTS: Of the 281 undergraduate medical students, 195 (69.3%) were female. Mean age of participants was 25.0 ± 2.6 years. In the EFA, the KMO was 0.720 and the Bartlett sphericity test was significant (p < 0.001). We conducted the EFA into two factors: role-modeling cost-conscious behaviors in health (seven items) and health waste behaviors (six items). The 13 item-scale was submitted to composite reliability analyzes, obtaining values of 0.813 and 0.761 for the role-modeling cost-conscious behaviors and the health waste behaviors factors, respectively. CONCLUSIONS: We concluded that the cost-conscious behaviors scale has good psychometric properties and is a valid and reliable instrument for evaluating medical students' perception of their teachers' cost-conscious behaviors.

PRE-OPERATIVE BILIARY DRAINAGE IN THE PERIAMPULLARY NEOPLASIA - A SYSTEMATIC REVIEW.

INTRODUCTION: Periampular neoplasms represent 5% of all cancers of the gastrointestinal tract with peak incidence in the 7th decade of life. The most common clinical picture is jaundice, weight loss and abdominal pain. Considering that cholestasis is related to postoperative complications, preoperative biliary drainage was developed to improve the postoperative morbidity and mortality of icteric patients with periampular neoplasias, whether resectable or not. OBJECTIVE: To describe the outcome of patients with periampullary tumors undergoing preoperative biliary drainage with pancreatoduodenectomy. METHOD: The search was performed in the Medline/PubMed and Virtual Health Library databases by means of the combination of descriptors of the Medical Subject Headings. Inclusion criteria were clinical trials, cohorts, studies that analyze the morbidity and mortality of preoperative biliary drainage in Portuguese, English and Spanish. Exclusion criteria were studies published more than 10 years ago, experimental studies, systematic reviews and articles with WebQualis C or smaller journal in the area of ​​Medicine I or Medicine III. Of the 196 references found, 46 were obtained for reading with quality assessed through the Checklist Strengthening the Reporting of Observational Studies in Epidemiology. Eight studies were selected for review. RESULTS: A total of 1116 patients with a sample ranging from 48 to 280 patients and a mean age of 48 to 69 years were obtained. Of the eight studies, four observed a higher rate of bleeding in drained patients; three a higher rate of positive bile culture in the intervention group; site and cavitary infection, and biliopancreatic leaks were more common in the drainage group in two studies each. The death outcome and rate of reoperation were observed in larger numbers in the control group in one study each. CONCLUSION: Preoperative intervention leads to a higher rate of infectious complications and bleeding.

Pre-operative biliary drainage in the periampullary neoplasia - a systematic review / Drenagem biliar pré-operatória na neoplasia periampular - uma revisão sistemática

ABSTRACT Introduction: Periampular neoplasms represent 5% of all cancers of the gastrointestinal tract with peak incidence in the 7th decade of life. The most common clinical picture is jaundice, weight loss and abdominal pain. Considering that cholestasis is related to postoperative complications, preoperative biliary drainage was developed to improve the postoperative morbidity and mortality of icteric patients with periampular neoplasias, whether resectable or not. Objective: To describe the outcome of patients with periampullary tumors undergoing preoperative biliary drainage with pancreatoduodenectomy. Method: The search was performed in the Medline/PubMed and Virtual Health Library databases by means of the combination of descriptors of the Medical Subject Headings. Inclusion criteria were clinical trials, cohorts, studies that analyze the morbidity and mortality of preoperative biliary drainage in Portuguese, English and Spanish. Exclusion criteria were studies published more than 10 years ago, experimental studies, systematic reviews and articles with WebQualis C or smaller journal in the area of ​​Medicine I or Medicine III. Of the 196 references found, 46 were obtained for reading with quality assessed through the Checklist Strengthening the Reporting of Observational Studies in Epidemiology. Eight studies were selected for review. Results: A total of 1116 patients with a sample ranging from 48 to 280 patients and a mean age of 48 to 69 years were obtained. Of the eight studies, four observed a higher rate of bleeding in drained patients; three a higher rate of positive bile culture in the intervention group; site and cavitary infection, and biliopancreatic leaks were more common in the drainage group in two studies each. The death outcome and rate of reoperation were observed in larger numbers in the control group in one study each. Conclusion: Preoperative intervention leads to a higher rate of infectious complications and bleeding.

RESUMO Introdução : Neoplasias periampulares representam 5% de todos os cânceres do trato gastrointestinal com pico de incidência na sétima década de vida. O quadro clínico mais comum é icterícia, perda de peso e dor abdominal. Considerando que a colestase está relacionada às complicações pós-cirúrgicas, a drenagem biliar pré-operatória foi desenvolvida objetivando melhorar a morbimortalidade pós-operatória de pacientes ictéricos com neoplasias periampulares, sejam elas ressecáveis ou não. Objetivo : Descrever o desfecho de pacientes com tumores periampulares submetidos à pancreatoduodenectomia com drenagem biliar pré-operatória. Método : A busca foi realizada nas bases de dados Medline/PubMed e Biblioteca Virtual em Saúde por meio da combinação de descritores do Medical Subject Headings. Os critérios de inclusão foram ensaios clínicos, coortes, estudos que analisam a morbimortalidade da drenagem biliar pré-operatória em português, inglês e espanhol. Os critérios de exclusão foram estudos publicados há mais de 10 anos, estudos experimentais, revisões sistemáticas e artigos com revista WebQualis C ou menor na área de Medicina I ou Medicina III. Das 196 referências encontradas, 46 foram obtidas para a leitura com qualidade avaliada através do checklist Strengthening the Reporting of Observational Studies in Epidemiology. Oito estudos foram selecionados para a revisão. Resultados : Obteve-se 1116 pacientes com variação de amostra de 48 a 280 pacientes e média de idade de 48 a 69 anos. Dos oito estudos, quatro observaram maior taxa de sangramento em pacientes drenados; três maior taxa de cultura de bile positiva no grupo intervenção; infecção de sítio e cavitária, além de vazamentos biliopancreáticos foram mais comuns no grupo da drenagem em dois estudos cada. O desfecho morte e a taxa de reoperação foram observados em maior quantidade no grupo controle em um estudo cada. Conclusão : A intervenção pré-operatória leva a maior taxa de complicações infecciosas e sangramentos.