Desenvolvimento de um aplicativo para ensino de ultrassonografia pulmonar em emergência / Development of an application for teaching pulmonary ultrasound in an emergency

Resumo: Introdução: A utilização de protocolos de ultrassonografia revolucionou o atendimento na medicina de emergência e pode auxiliar no diagnóstico de insuficiência respiratória no pronto atendimento. Assim, torna-se importante o treinamento médico para a utilização desses protocolos. Já foi demonstrado também que os aplicativos de smartphone médico têm resultados positivos na prática diária, além de serem uma ferramenta educacional potencialmente valiosa. Objetivo: Dessa forma, o objetivo deste estudo foi desenvolver um aplicativo em ultrassonografia pulmonar de emergência. O BLUE SIM é um aplicativo de celular que simula atendimentos de casos clínicos utilizando o protocolo Bedside Lung Ultrasound in Emergency, o qual pode auxiliar alunos e profissionais da área da saúde a usar a ultrassonografia pulmonar no atendimento da insuficiência respiratória aguda. A hipótese é que o BLUE SIM será um aplicativo usável e aceitável entre os usuários. Método: Após desenvolvido, avaliou-se o aplicativo com 36 voluntários: 18 fisioterapeutas, um médico, sete enfermeiros e dez acadêmicos de Medicina. Analisaram-se a usabilidade e a utilidade de uma aplicação móvel para o sistema iOS, utilizando como referências a escala de usabilidade System Utility Score (SUS) e o modelo de aceitação Technology Acceptance Model (TAM). Os dados obtidos foram tabulados e analisados pelo teste exato de Fisher ou Mann-Whitney. Resultado: Pela aplicação do questionário SUS (usabilidade), o aplicativo obteve um escore de 76,8%. Exclusivamente entre os fisioterapeutas, obteve-se um escore de 75%, não havendo diferença estatística entre o grupo geral de todos os profissionais emergencistas e o grupo somente de fisioterapeutas (p = 0,239). Segundo a análise de percepção de utilidade, 93,9% dos profissionais emergencistas responderam positivamente, enquanto, entre os fisioterapeutas, obteve-se um escore de 88,9% (p = 0,04). Conclusão: O aplicativo desenvolvido foi classificado de utilidade na aprendizagem do diagnóstico de insuficiência respiratória entre os profissionais, contudo eles consideraram que é necessário um treinamento para o uso da ferramenta.

Abstract: Introduction: The use of ultrasound protocols has revolutionized care in emergency medicine and can help in the diagnosis of respiratory failure in emergency care; therefore, medical training for the use of these protocols has become important. It has also been demonstrated that medical smartphone apps have positive results in daily practice, in addition to being a potentially valuable educational tool. Objective: Thus, the objective was to develop an emergency pulmonary ultrasound application. The "BLUE SIM" is a cell phone application that simulates clinical cases using the "Bedside Lung Ultrasound in Emergency" protocol, which can help students and health professionals regarding the use of pulmonary ultrasound in the care of acute respiratory failure. The hypothesis is that the "BLUE SIM" will be a usable and acceptable application among users. Method: After the development, the application was evaluated with a group of 36 volunteers, which included 18 physical therapists and 18 other professionals consisting of physicians, nurses and medical students. The usability and usefulness of a mobile application for the iOS system was analyzed, using the System Utility Score (SUS) usability scale and the Technology Acceptance Model (TAM) as references. The obtained data were tabulated and analyzed using Fisher's exact test or Mann-Whitney test. Result: When applying the SUS questionnaire (usability), the application obtained a score of 76.8%. A score of 75% was obtained exclusively among physical therapists, with no statistical difference between the general group of all emergency professionals and the group of physical therapists only (p=0.239). According to the usefulness perception analysis, 93.9% of the emergency professionals had a positive response, while a score of 88.9% was obtained among physical therapists (p=0.04). Conclusion: It was concluded that the developed application was classified as useful in learning the diagnosis of respiratory failure among health professionals; however, they considered that training is necessary for its use.

Technology acceptance by professors and adherence of undergraduate dental students to virtual classes during COVID-19 pandemic / Aceitação de tecnologia por professores e adesão de alunos de graduação em Odontologia a aulas virtuais durante a pandemia COVID-19

The aim of this study wastoanalyse the acceptance of technology by professors and the adherence of dental students to virtual teachingduring the social distancing period due to the coronavirus disease (COVID-19) pandemic. This was a retrospective observational cross-sectional study that involved the anonymous opinion of dental schoolprofessors. After each virtual class, the professorsfilled out the e-questionnaire aboutthe remote activities(discipline identification, method used, number of students, satisfaction of the professor, and a technology acceptance model questionnaire) performed between 18 March and 18 May (60 days of virtualisation of theoretical classes during interruption of face-to-face classes). This study showed a good acceptability of this learning technologyby professors(TAM score 81.82 ± 11.79). During the pandemic, live video conferencing classes (n = 632, 63.6%) were the most preferred method of teachingby professors, followed by previously recorded video lessons (n = 403, 40.5%). Theacceptability of professors was strongly associated with the perception of the quality of interaction (p <0.001).Higherstudentparticipation was significantly associated with live videoconference classes (p = 0.019).Prioravailability of articles or documents for study (p = 0.028)andthe absence of technological complications during the virtual classes (p = 0.003)significantly increased acceptability.In conclusion, the virtual class technology usedduring the COVID-19pandemic period was well accepted by professors at a dental school and had good adherence by students, especially in videoconferencing classes (AU).

O objetivo deste estudo foi analisar a aceitação da tecnologia por professores e a adesão dos alunos de odontologia ao ensino virtual durante o período de distanciamento social devido à pandemia do coronavírus (COVID-19). Este foi um estudo transversal observacional retrospectivo que envolveu a opinião anônima de professores de escolasde odontologia. Após cada aula virtual, os professores preencheram um questionário sobre as atividades remotas (identificação da disciplina, método utilizado, número de alunos, satisfação do professor e questionário do modelo de aceitação de tecnologia) realizado entre 18 de março e 18 de maio (60 dias de virtualização das aulas teóricas durante a interrupção das aulas presenciais). Este estudo mostrou uma boa aceitabilidade desta tecnologia de aprendizagem pelos professores (pontuação TAM 81,82 ± 11,79). Durante a pandemia, aulas de videoconferência ao vivo (n = 632, 63,6%) foram o método de ensino preferido pelos professores, seguido por vídeo aulas previamente gravadas (n = 403, 40,5%). A aceitabilidade dos professores esteve fortemente associada à percepção da qualidade da interação (p <0,001). A maior participação dos alunos foi significativamente associada às aulas de videoconferência (p = 0,019). A disponibilidade prévia de artigos ou documentos para estudo (p = 0,028) e a ausência de complicações tecnológicas durante as aulas virtuais (p = 0,003) aumentaram significativamente a aceitabilidade. Concluindo, a tecnologia da aula virtual usada durante o período pandêmico do COVID-19 foi bem aceita pelos professores de uma faculdade de odontologia e teve boa aderência dos alunos, principalmente nas aulas de videoconferência (AU).

Evaluation of Usability, Perception of Usefulness, and Efficiency of an Application in Interpreting Imaging Examinations and Supporting Decision-Making in Orthopedics.

Background: Medical smartphone applications have rendered positive results in daily practice and also serve as potentially valuable educational tools. In orthopedics, radiograph analysis and angle measurements comprise an essential mechanism in the diagnosis, treatment, planning, and evaluation of the results in orthopedic surgery. Purpose: Thus, the present study aimed to evaluate an application for mobile devices for orthopedic doctors and orthopedic residents. The application proposes the analysis and interpretation of radiographic imaging examinations through assessments and angle measurements. In this survey, we analyzed the parameter usability and usefulness of a mobile application for the iOS system, in addition to conducting its validation. Patients and Methods: The application was tested by 26 volunteers: 13 orthopedists and 13 orthopedic residents. Results: After applying the System Utility Score (SUS) questionnaire, which assesses the usability of an application, a score of 84.5 was obtained, a value that represents an A+ rating on the Sauro and Lewis scale. There was no statistically significant difference when comparing the SUS between the orthopedic residents and orthopedists. According to the usefulness perception analysis, 90% of the residents responded positively to the questions, while among orthopedists, the percentage was 75%, denoting a statistically significant difference (p = 0.002). Subsequently, the application underwent validation to assess whether the calculated angle measurements were reliable when compared with those obtained using the goniometer. No significant differences were observed when comparing the angles measured by the two evaluated methods. Conclusion/Clinical Relevance: In conclusion, the developed application can reliably contribute to the measurement of angles in radiographs, assisting in therapeutic decision-making, and may be used as an instrument to promote the teaching and learning processes in orthopedics.

Influence of the degree of conversion and Bis-GMA residues of bulk fill resins on tissue toxicity in an subcutaneous model in rats.

AIM: To analyse the influence of the degree of conversion (DC) and light curing residues of different bulk fills (BFs) composites on the inflammatory profile in the subcutaneous tissue of rats. MATERIALS AND METHODS: Resin disks of BF-resins and their active conventional resins (CR; 3M®, Ivoclar®, and Kerr®) were light-cured at 2 mm (BF-superficial) and 4 mm (BF-deep) thicknesses and analyzed by infrared spectroscopy (FTIR; n = 3/group; DC and light curing residues). Then, the disks were implanted in four quadrants in the subcutaneous tissue of Wistar rats (sham, CR, BF-superficial and RF-deep), and after 7, 14, and 28 days, the animals (n = 6/day) were euthanized for histological analysis of the intensity of the inflammatory process (scores 0-3). Kruskal-Wallis/Dunn and ANOVA/Bonferroni tests were used (p < 0.05, Graph Pad Prism 5.0). RESULTS: The DC of CR 3M® did not differ significantly compared to BF-superficial and BF-deep resins (p = 0.235). The Ivoclar® and Kerr® resins showed a higher DC with CR and BF-superficial compared to the BF-deep (p = 0.005 and p = 0.011, rctively). Kerr® resins showed a higher Bis-GMA/UDMA ratio, especially in BF-deep resin (p < 0.05). 3M® and Ivoclar resins did not show high inflammation scores, but for Kerr® BF resins (superficial and deep), the inflammatory process was significantly higher than that in the CR and sham quadrants (p = 0.031). CONCLUSION: The tissue inflammatory response after resin inoculation depends on the DC and light curing residues of Bis-GMA.

Endovascular technique simulator for Neuroradiology learning / Simulador de técnica endovascular para aprendizado de Neurorradiologia

ABSTRACT Background: Vascular cerebral infarction (or stroke) is recognized as the third leading cause of death worldwide, and acute arterial occlusion comprises the main mechanism underlying ischemic stroke. Cerebrovascular diseases are treated by intracranial endovascular interventions employing minimally invasive intravascular techniques, such as neuroimaging. Conducting practical training in this area is a necessary task since patient safety is a considerably significant factor. There has been a steady increase in scientific research focused on validating endovascular simulation as a tool for training interventionists in endovascular procedures. Current literature confirms the idea that there is a beneficial role of simulation in endovascular training and skill acquisition and technique improvement. Objective: To develop an endovascular technique simulator for learning Neuroradiology. Methods: The methodology consisted of developing a simulator using 3D printing technology. Results: A literature search was carried out, commencing in August 2017, through consultation of the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) databases, using the PubMed and BIREME websites, respectively. Meetings were held between the neuroradiologist specialist and programmers to develop the simulator, which was carried out in three phases: design of the arterial system, design of the prototype of the arterial system in computer graphics, and confection of the arterial system simulator in 3D. Conclusion: The simulator is ready for testing by residents and can enable the student to learn through simulations that reproduce, as realistically as possible, the situation to be subsequently experienced using a concrete tool.

RESUMO Introdução: O acidente vascular cerebral (AVC) é a terceira causa de morte em todo o mundo e uma oclusão arterial aguda é o principal mecanismo subjacente ao AVC isquêmico. As doenças cerebrovasculares são tratadas por intervenções endovasculares intracranianas utilizando técnicas intravasculares minimamente invasivas, como a neuroimagem. Realizar treinamento prático nessa área é uma tarefa necessária, pois a segurança do paciente é um fator considerado significativo. Houve um aumento constante de pesquisas científicas focada na validação da simulação endovascular como uma ferramenta para treinar intervencionistas em procedimentos endovasculares. A literatura atual confirma a ideia de que existe um papel benéfico da simulação no treinamento endovascular e na aquisição de habilidades e aprimoramento da técnica. Objetivo: Desenvolver um simulador de técnica endovascular para o aprendizado de Neurorradiologia. Métodos: Desenvolvimento de um simulador utilizando a tecnologia de impressão em 3D. Resultados: Realizou-se uma pesquisa bibliográfica da literatura, tendo início em Agosto de 2017, com consulta feita ao banco de dados Medical Literature Analysis and Retrievel System on Line (MEDLINE) e Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), por meio respectivamente dos sites PubMed e BIREME. Foram realizadas reuniões entre o especialista em Neurorradiologia e os programadores para desenvolver o simulador, que foi realizado em três fases: desenho do sistema arterial, desenho do protótipo do sistema arterial em computação gráfica e confecção do simulador do sistema arterial em 3D. Conclusão: O simulador está pronto para ser testado por residentes, podendo possibilitar ao aluno aprender por simulações que reproduzem, da forma mais realista possível, a situação a ser vivenciada posteriormente usando uma ferramenta concreta.

Endovascular technique simulator for Neuroradiology learning.

BACKGROUND: Vascular cerebral infarction (or stroke) is recognized as the third leading cause of death worldwide, and acute arterial occlusion comprises the main mechanism underlying ischemic stroke. Cerebrovascular diseases are treated by intracranial endovascular interventions employing minimally invasive intravascular techniques, such as neuroimaging. Conducting practical training in this area is a necessary task since patient safety is a considerably significant factor. There has been a steady increase in scientific research focused on validating endovascular simulation as a tool for training interventionists in endovascular procedures. Current literature confirms the idea that there is a beneficial role of simulation in endovascular training and skill acquisition and technique improvement. OBJECTIVE: To develop an endovascular technique simulator for learning Neuroradiology. METHODS: The methodology consisted of developing a simulator using 3D printing technology. RESULTS: A literature search was carried out, commencing in August 2017, through consultation of the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) databases, using the PubMed and BIREME websites, respectively. Meetings were held between the neuroradiologist specialist and programmers to develop the simulator, which was carried out in three phases: design of the arterial system, design of the prototype of the arterial system in computer graphics, and confection of the arterial system simulator in 3D. CONCLUSION: The simulator is ready for testing by residents and can enable the student to learn through simulations that reproduce, as realistically as possible, the situation to be subsequently experienced using a concrete tool.

Antimicrobial effect of anacardic acid-loaded zein nanoparticles loaded on Streptococcus mutans biofilms.

Bacterial biofilms play a key role in the pathogenesis of major oral diseases. Nanoparticles open new paths for drug delivery in complex structures such as biofilms. This study evaluated the antimicrobial effect of zein nanoparticles containing anacardic acid (AA) extracted from cashew shells of Anacardium occidentale on in vitro Streptococcus mutans biofilm formation and mature biofilms. The minimum inhibitory concentration (MIC), minimum bacterial concentration (MBC), and antibiofilm assays were performed. Streptococcus mutans UA159 biofilms were formed on saliva-coated hydroxyapatite disk for 5 days. To evaluate the preventive effect on biofilm formation, before contact with the inoculum, the disks were immersed once for 2 min in (1) hydroethanolic solution; (2) blank zein nanoparticles; (3) zein nanoparticles containing AA; and (4) 0.12% chlorhexidine gluconate. To determine the effect against mature biofilms, the disks containing 5-day preformed biofilms were further treated using the same procedure. The bacterial viability and dry weight were determined for both assays and used to compare the groups using ANOVA followed by Tukey's test (p < 0.05). Both MIC and MBC for AA-loaded zein nanoparticles were 0.36 µg/mL. Groups 3 and 4 were very effective in inhibiting S. mutans biofilm formation, as no colony-forming units were detected. In contrast, for mature biofilms, no difference in bacterial viability (p = 0.28) or dry weight (p = 0.09) was found between the treatments. Therefore, the AA-based nanoformulation presented very high inhibitory and bactericidal activities against planktonic S. mutans, and the results indicate a strong antiplaque effect. However, the formulation showed no antimicrobial effect on the established biofilm.

Characterization of antimicrobial photodynamic therapy-treated Streptococci mutans: an atomic force microscopy study.

UNLABELLED: Abstract Objective: The aim of the present study was to examine the size and shape of Streptococcus mutans bacterial cells of infected dentin substrate subjected to photodynamic therapy (PDT) using atomic force microscopy (AFM). BACKGROUND DATA: New trends in the application of AFM have been developed in the field of dentistry, making AFM a useful technique in high resolution imaging of biological structures and processes. MATERIALS AND METHODS: PDT was completed using an efficient light-emitting diode source (LED - λ=620-660 nm) with total light dose of 94 J/cm(2) in the presence of the photosensitizer toluidine blue O (TBO). Dentin specimens were immersed in brain heart infusion (BHI) broth inoculated with S. mutans for 5 days to induce caries in vitro. After demineralization, the samples were subjected to a series of treatments in which carious dentin infected by S. mutans was exposed to 0.9% sodium chlorite (NaCl) solution (control) for 10 min, or subjected to PDT-TBO photosensitizer followed by light exposure (energy density of 94 J/cm(2)). RESULTS: Three-dimensional (3-D) images and cross-sectional measurements showed rod and diplococcic cell shapes. Photoinactivated bacterial cells did not differ from the control with respect to their cross-sectional shape, but they did show a reduction in size. CONCLUSIONS: Photodynamic therapy decreased the diameter of S. mutans cells and AFM may be used as a technique for bacterial cell analysis.