Where do we invest money to implement active learning on caries detection? An economic evaluation.

This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8-8.1), and the total cost of the teaching activity would be $684 (IQR:672-696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved.

Infections in patients hospitalized for external causes in Intensive Care Units / Infecciones en pacientes hospitalizados por causas externas en Unidades de Cuidados Intensivos / Infecções em pacientes internados por causas externas em Unidades de Terapia Intensiva

Background and Objectives: given the great demand for hospitalization due to external causes, as well as the growing number of cases of infections in health services, it can be said that these are important issues and that they represent a huge challenge to be faced by professionals and health managers around the world. Therefore, this article aims to describe the profile of individuals hospitalized for external causes in an Intensive Care Units (ICUs) who underwent a culture test and identify the main microorganisms that cause infection. Methods: a cross-sectional study carried out with patients suffering from external causes, admitted to an ICU of a general hospital in Bahia. The data were analyzed using descriptive statistics, presented in absolute and relative frequencies. Results: a total of 259 admissions to the ICU due to external causes were identified, of which 59 (22.78%) underwent cultures, of which 48 (81.35%) were men, 43 (72.88%) were brown, 32 (54.24%) did not have a partner and 35 (59.32%) suffered transport accidents. Regarding the use of devices, 54 (91.52%) patients were on invasive mechanical ventilation, 54 (91.50%) used an indwelling urinary catheter and 54 (91.52%) had a central venous catheter. The main microorganisms identified in the culture were of the genera Staphylococcus (17; 28.9%) and Pseudomonas (10; 16.9%). Conclusion: it is concluded that admissions to ICU resulting from external causes in patients who underwent culture were of men, who suffered transport accidents, used invasive devices, and the main infections are related to microorganisms of the genus Staphylococcus.(AU)

Antecedentes y Objetivos: Dada la gran demanda de hospitalización debido a causas externas, así como el creciente número de casos de infecciones en servicios de salud, se puede decir que estos son temas importantes y representan un enorme desafío a enfrentar por profesionales y gestores de salud en todo el mundo. Por lo tanto, este artículo tiene como objetivo describir el perfil de los individuos hospitalizados por causas externas en Unidades de Cuidados Intensivos (UCI) que se sometieron a una prueba de cultivo e identificar los principales microorganismos que causan infección. Métodos: Se realizó un estudio transversal con pacientes que sufrían causas externas, admitidos en una UCI de un hospital general en Bahía. Los datos se analizaron utilizando estadísticas descriptivas, presentadas en frecuencias absolutas y relativas. Resultados: Se identificó un total de 259 ingresos a la UCI debido a causas externas, de los cuales 59 (22,78%) se sometieron a cultivos, de los cuales 48 (81,35%) eran hombres, 43 (72,88%) eran pardos, 32 (54,24%) no tenían pareja y 35 (59,32%) sufrieron accidentes de transporte. En cuanto al uso de dispositivos, 54 (91,52%) pacientes estaban en ventilación mecánica invasiva, 54 (91,50%) usaron catéter urinario de demora y 54 (91,52%) tenían un catéter venoso central. Los principales microorganismos identificados en el cultivo fueron del género Staphylococcus (17; 28,9%) y Pseudomonas (10; 16,9%). Conclusión: Se concluye que los ingresos a la UCI resultantes de causas externas en pacientes que se sometieron al cultivo fueron de hombres, que sufrieron accidentes de transporte, usaron dispositivos invasivos, y las principales infecciones están relacionadas con microorganismos del género Staphylococcus.(AU)

Justificativa e Objetivos: Dada a grande demanda por hospitalização devido a causas externas, assim como o crescente número de casos de infecções em serviços de saúde, pode-se dizer que esses são temas importantes e representam um enorme desafio a ser enfrentado por profissionais e gestores de saúde ao redor do mundo. Portanto, este artigo tem como objetivo descrever o perfil dos indivíduos hospitalizados por causas externas em Unidades de Terapia Intensiva (UTIs) que se submeteram a um teste de cultura e identificar os principais microrganismos que causam infecção. Métodos: Um estudo transversal foi realizado com pacientes que sofriam de causas externas, admitidos em uma UTI de um hospital geral na Bahia. Os dados foram analisados utilizando estatísticas descritivas, apresentadas em frequências absolutas e relativas. Resultados: Um total de 259 internações na UTI devido a causas externas foi identificado, dos quais 59 (22,78%) foram submetidos a culturas, sendo 48 (81,35%) homens, 43 (72,88%) pardos, 32 (54,24%) não tinham parceiro e 35 (59,32%) sofreram acidentes de transporte. Em relação ao uso de dispositivos, 54 (91,52%) pacientes estavam em ventilação mecânica invasiva, 54 (91,50%) usaram cateter urinário de demora e 54 (91,52%) tinham um cateter venoso central. Os principais microrganismos identificados na cultura foram dos gêneros Staphylococcus (17; 28,9%) e Pseudomonas (10; 16,9%). Conclusão: Conclui-se que as internações na UTI decorrentes de causas externas em pacientes que se submeteram à cultura foram de homens, que sofreram acidentes de transporte, usaram dispositivos invasivos, e as principais infecções estão relacionadas a microrganismos do gênero Staphylococcus. (AU)

Where do we invest money to implement active learning on caries detection? An economic evaluation

Abstract This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8-8.1), and the total cost of the teaching activity would be $684 (IQR:672-696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved.

Kaurenoic Acid Reduces Ongoing Chronic Constriction Injury-Induced Neuropathic Pain: Nitric Oxide Silencing of Dorsal Root Ganglia Neurons.

Kaurenoic acid (KA) is a diterpene extracted from Sphagneticola trilobata (L.) Pruski. KA presents analgesic properties. However, the analgesic activity and mechanisms of action of KA in neuropathic pain have not been investigated so far; thus, we addressed these points in the present study. A mouse model of neuropathic pain was induced by chronic constriction injury (CCI) of the sciatic nerve. Acute (at the 7th-day post-CCI surgery) and prolonged (from 7-14th days post-CCI surgery) KA post-treatment inhibited CCI-induced mechanical hyperalgesia at all evaluated time points, as per the electronic version of von Frey filaments. The underlying mechanism of KA was dependent on activating the NO/cGMP/PKG/ATP-sensitive potassium channel signaling pathway since L-NAME, ODQ, KT5823, and glibenclamide abolished KA analgesia. KA reduced the activation of primary afferent sensory neurons, as observed by a reduction in CCI-triggered colocalization of pNF-κB and NeuN in DRG neurons. KA treatment also increased the expression of neuronal nitric oxide synthase (nNOS) at the protein level as well as the intracellular levels of NO in DRG neurons. Therefore, our results provide evidence that KA inhibits CCI neuropathic pain by activating a neuronal analgesic mechanism that depends on nNOS production of NO to silence the nociceptive signaling that generates analgesia.

Análise da variação morfológica em Bothrops moojeni e espécies associadas

The genus Bothrops comprises a group of venomous snakes widely distributed throughout the Neotropics and presents a complex pattern of morphological variation. Among Bothrops species, the atrox group is composed by: B. atrox Linnaeu, 1758; B. leucurus Wagler, 1824; B. moojeni Hoge, 1966; B. marajoensis Hoge, 1966; B. asper Garman, 1883; B. isabelae Sandner Montilla, 1979; B. colombienses Hallowell; B. caribbaeus Garman, 1887 and B. lanceolatus Bonnaterre, 1790. The difficulty of morphological characterization of the species of this group has stimulated several discussions among researchers about the taxonomic validity of some representatives and their real geographic limits. This paper brings a taxonomic revision of the species of B. moojeni through the use of morphological evidence. Populations of B. atrox and B. leucurus historically associated with B. moojeni were also analyzed. Morphometric, meristic characters and drawing and coloration patterns of 362 specimens were analyzed, and statistical analyses were performed among the species. The study was conducted at the Laboratory of Zoological Collections of the Instituto Butantan. The described characteristics of the studied species showed similarities, demonstrating the recurring difficulty in identifying them. Furthermore, overlapping populations were recorded in the Cerrado region between B. atrox and B. moojeni, and the latter with B. leucurus in areas near the Atlantic Forest. A Principal Component Analysis (PCA) was used to show sexual dimorphism among species, and Boxplot, Plot and Histogram charts were used to observe the analyses. The morphological and meristic analyses of B. moojeni, B. atrox and B. leucurus in this study showed significant dimorphism in twelve of the 32 variables analyzed. We observed significant differences in B. atrox in the amount of ventral and sub-caudal scales, as well as in head width. The combination of these results demonstrates that the diversity of the atrox group is complex and its characters overlap across the three species, making morphological relationships among them similar. However, to better understand the differentiation between the species analyzed further research through phylogenetic and molecular analyses and to analyze more specimens will be necessary.

O gênero Bothrops compreende um grupo de serpentes peçonhentas amplamente distribuídas pela região neotropical e apresenta um complexo padrão de variação morfológica. Dentre as espécies de Bothrops, o grupo atrox é composto por: B. atrox Linnaeu, 1758; B. leucurus Wagler, 1824; B. moojeni Hoge, 1966; B. marajoensis Hoge, 1966; B. asper Garman, 1883; B. isabelae Sandner Montilla, 1979; B. colombienses Hallowell; B. caribbaeus Garman, 1887 e B. lanceolatus Bonnaterre, 1790. A dificuldade de caracterização morfológica das espécies deste grupo impulsiona várias discussões entre pesquisadores sobre a validade taxonômica de alguns representantes e seus reais limites geográficos. Este trabalho traz uma revisão taxonômica da espécie de B. moojeni através do uso de evidências morfológicas. Também foram analisadas populações de B. atrox e B. leucurus historicamente associadas a B. moojeni. Foram analisados caracteres morfométricos, merísticos e padrão de desenho e coloração de 362 espécimes, efetuando as análises estatísticas entre as espécies. O estudo foi conduzido no Laboratório de Coleções Zoológicas do Instituto Butantan. As características descritas das espécies estudadas apresentaram semelhanças, demonstrando a dificuldade recorrente na identificação das mesmas. Além disso, foram registradas sobreposições de populações na região de Cerrado entre B. atrox e B. moojeni e esta última com B. leucurus em áreas próximas da Mata Atlântica. Uma Análise de Componentes Principais (PCA) foi utilizada para evidenciar o dimorfismo sexual dentre as espécies, além de serem utilizados gráficos de Boxplot, Plotagem e Histogramas para a observação das análises. As análises morfológicas e merísticas de B. moojeni, B. atrox e B. leucurus deste estudo apresentaram dimorfismos significativos em doze das 32 variáveis analisadas. Observamos diferenças significativas em B. atrox na quantidade de escamas ventrais e subcaudais, assim como na largura da cabeça. A combinação destes resultados demonstra que a diversidade do grupo atrox é complexa e seus caracteres se sobrepõem às três espécies, tornando relações morfológicas entre elas semelhantes. No entanto, para compreender melhor a diferenciação entre as espécies analisadas serão necessárias novas pesquisas através de análises filogenéticas e moleculares e analisar mais espécimes.

Experiências de doentes críticos com a ventilação mecânica invasiva / Experiences of critically ill patients with invasive mechanical ventilation

O objetivo deste estudo foi conhecer as experiências vividas por pacientes que fizeram uso de ventilação mecânica invasiva em Unidades de Terapia Intensiva de dois hospitais do extremo sul do Brasil. A presente pesquisa foi conduzida na perspectiva qualitativa, sendo realizada com 10 pacientes que salientaram suas principais dificuldades e necessidades durante o período em que fizeram uso de ventilação mecânica invasiva. Os resultados apontam que as dificuldades relatadas relacionaram-se especialmente com a presença da via aérea artificial, sendo elas: sensação de sufocamento, náuseas, lesões decorrentes do tubo endotraqueal, acúmulo de secreções no tubo endotraqueal e cavidade oral e afonia. Além disso, os pacientes referiram necessidades de comunicação, sede e alterações da rotina pessoal. Os achados deste estudo elucidaram a vivência do paciente crítico, mediante esse recurso invasivo, trazendo elementos importantes a serem considerados para o cuidado de enfermagem.

The aim of this study was to identify the experiences of patients who used invasive mechanical ventilation in intensive care units of two hospitals in Southern Brazil. This research was conducted in a qualitative way, consisting of 10 interviewees, who emphasized their main difficulties and necessities during the period in which they used invasive mechanical ventilation. The results indicate that the difficulties reported were specially related to the presence of the artificial airway, such as: suffocation felling, nausea, injuries caused by the endotracheal tube, accumulation of secretions in the endotracheal tube and oral cavity and aphonia. In addition, the patients reported other problems such as: communication needs, thirst, and changes in their personal routine. Our findings elucidated the experience of critically ill patients through this invasive feature, bringing important issues to be considered for nursing care.

El objetivo de este estudio fue conocer las experiencias de los pacientes que hicieron uso de la ventilación mecánica invasiva en Unidades de Cuidados Intensivos de dos hospitales en el extremo sur de Brasil. La presente investigación fue conducida en la perspectiva cualitativa, siendo compuesta por 10 entrevistados, que destacaron sus principales dificultades y necesidades durante el periodo en que hicieron uso de ventilación mecánica invasiva. Los resultados apuntan que las dificultades relatadas se relacionaron especialmente a la presencia de la vía aérea artificial, siendo ellas: sensación de sofocarse, náuseas, lesiones decurrentes del tubo endotraqueal, acumulo de secreciones en el tubo endotraqueal, cavidad oral y afonía. También los pacientes refirieron necesidades comunicacionales, sede y alteraciones de la rutina personal. Los hallazgos de este estudio elucidaron la vivencia del paciente crítico mediante este recurso invasivo, trayendo puntos importantes a considerarse para el cuidado de enfermería.