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1.
JMIR Public Health Surveill ; 7(3): e24795, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33630746

RESUMO

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.


Assuntos
COVID-19 , Educação Médica/organização & administração , Estudantes de Medicina/psicologia , Telemedicina/organização & administração , Brasil/epidemiologia , Humanos , Aprendizagem , Estudos de Casos Organizacionais , Participação Social
2.
Hepatobiliary Surg Nutr ; 5(2): 176-82, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27115012

RESUMO

Currently in Brazil, living donor liver transplantation (LDLT) represents 8.5% of liver transplantation (LT), being the majority pediatric one. Up to now, according to Brazilian Organ Transplantation Association (ABTO) annual report, 2,086 procedures have been done nationwide, most of them in southeast and south regions. Based on national centers reports, biliary complication is the most common recipient postoperative complication (14.5-20.6%), followed by hepatic artery thrombosis (3.1-10.7%) and portal vein thrombosis (2.3-9.1%). Patient and graft overall 5-y survival correspond to 76% and 74%, respectively. Regarding the donor, morbidity rate ranges from 12.4% to 28.3%, with a national mortality rate of 0.14%. In conclusion, Brazilian LDLT programs enhance international experience that this is a feasible and safe procedure, as well as an excellent alternative strategy to overcome organs shortage.

3.
Ann Transplant ; 20: 320-6, 2015 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-26056159

RESUMO

BACKGROUND: The pig is an essential model for liver transplantation research and training. However, it develops hemodynamic instability during the anhepatic phase, requiring a short anhepatic phase or an extracorporeal circulation not appropriate for training purposes because it increases the risk of intraoperative complications. In this article we describe an economical and reproductive experimental model for training surgeon fellows in liver transplantation, without veno-venous bypass, using a supraceliac aortic cross-clamping maneuver. MATERIAL AND METHODS: After liver liberation, we cross-clamped the supraceliac aorta and cross-clamped and divided the infrahepatic inferior vena cava (IVC), bile duct (BD), hepatic artery (HA), portal vein (PV), and suprahepatic IVC. We rapidly removed and flushed the liver ex situ, repositioned it orthotopically, and performed anastomosis in suprahepatic IVC, infrahepatic IVC and PV, reperfusing the liver. Lastly, we anastomosed the HA and BD. We also performed pulmonary artery catheter exams and recovery blood samples serially before and after graft reperfusion (beginning of anesthesia = basal; 5 min after reperfusion and 120 min after reperfusion = end-point) for hemodynamic and metabolic assessment. RESULTS: Transplantation fellows were able to perform the operations assisted by a senior surgeon. The median procedure time was 211 min (188-233 min). One pig died due to hemorrhage and 5 remained alive for up to 2 h after liver reperfusion, achieving at this time normal hemodynamic and metabolic parameters. CONCLUSIONS: This model is suitable for training and experimentation, avoids venovenous bypass, is low cost, avoids immunological reaction, and prevents hemodynamic and metabolic complications.


Assuntos
Anastomose Cirúrgica/métodos , Aorta/cirurgia , Transplante de Fígado/métodos , Animais , Ductos Biliares/cirurgia , Feminino , Hemodinâmica , Artéria Hepática/cirurgia , Masculino , Modelos Anatômicos , Modelos Animais , Veia Porta/cirurgia , Suínos , Transplante Autólogo , Veia Cava Inferior/cirurgia
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