Pharmacokinetic/Pharmacodynamic Modeling and Application in Antibacterial and Antifungal Pharmacotherapy: A Narrative Review.

Pharmacokinetics and pharmacodynamics are areas in pharmacology related to different themes in the pharmaceutical sciences, including therapeutic drug monitoring and different stages of drug development. Although the knowledge of these disciplines is essential, they have historically been treated separately. While pharmacokinetics was limited to describing the time course of plasma concentrations after administering a drug-dose, pharmacodynamics describes the intensity of the response to these concentrations. In the last decades, the concept of pharmacokinetic/pharmacodynamic modeling (PK/PD) emerged, which seeks to establish mathematical models to describe the complete time course of the dose-response relationship. The integration of these two fields has had applications in optimizing dose regimens in treating antibacterial and antifungals. The anti-infective PK/PD models predict the relationship between different dosing regimens and their pharmacological activity. The reviewed studies show that PK/PD modeling is an essential and efficient tool for a better understanding of the pharmacological activity of antibacterial and antifungal agents.

Application of telesimulation in a medical undergraduate course during the SARS-CoV-2 pandemic: a quantitative and retrospective study

ABSTRACT BACKGROUND: Because of the social isolation and distancing measures that were imposed to stop the spread of coronavirus disease 19 (COVID-19), new ways of teaching were implemented. OBJECTIVES: To describe the implementation of telesimulation and seek to assess students' perceptions regarding telesimulation. DESIGN AND SETTING: Retrospective quantitative study conducted within the hospital simulation at a private medical school in São Paulo, Brazil. METHODS: After telesimulation training, students answered a questionnaire that provided an overall assessment of this activity, self-assessment and assessments of the facilitators and infrastructure provided by the University. RESULTS: Among the students, 50% reported that the activity was below expectations and 45% reported that it was in line with their expectations. The strong points of the activity were the clinical cases, workload and teachers. The main challenge was students' difficulty in reflecting on their learning and the infrastructure. CONCLUSIONS: Since students have less experience and fewer clinical encounters than residents or professionals, they also face more difficulty. Although telesimulation may have provided a valid alternative to replace simulation training during the COVID-19 pandemic, more face-to-face activities should be offered to students, when possible.

Application of telesimulation in a medical undergraduate course during the SARS-CoV-2 pandemic: a quantitative and retrospective study.

BACKGROUND: Because of the social isolation and distancing measures that were imposed to stop the spread of coronavirus disease 19 (COVID-19), new ways of teaching were implemented. OBJECTIVES: To describe the implementation of telesimulation and seek to assess students' perceptions regarding telesimulation. DESIGN AND SETTING: Retrospective quantitative study conducted within the hospital simulation at a private medical school in São Paulo, Brazil. METHODS: After telesimulation training, students answered a questionnaire that provided an overall assessment of this activity, self-assessment and assessments of the facilitators and infrastructure provided by the University. RESULTS: Among the students, 50% reported that the activity was below expectations and 45% reported that it was in line with their expectations. The strong points of the activity were the clinical cases, workload and teachers. The main challenge was students' difficulty in reflecting on their learning and the infrastructure. CONCLUSIONS: Since students have less experience and fewer clinical encounters than residents or professionals, they also face more difficulty. Although telesimulation may have provided a valid alternative to replace simulation training during the COVID-19 pandemic, more face-to-face activities should be offered to students, when possible.

Solutions, enablers and barriers to online learning in clinical medical education during the first year of the COVID-19 pandemic: A rapid review.

AIMS: The COVID-19 pandemic has seen a major disruption to undergraduate and postgraduate clinical medical education. The aim of this rapid review was to identify and synthesize published literature relating to the solutions, enablers and barriers to online learning implemented in clinical medical education during the first year of the COVID-19 pandemic. METHODS: All articles published before March 2021 in peer-reviewed journals, including MedEdPublish, that described authors' experience of online learning in response to the COVID-19 pandemic. A descriptive analysis of the solutions and a qualitative template analysis of enablers and barriers. RESULTS: 87 articles were identified for inclusion. Face to face teaching was maintained with interactive approaches between learners and/or learners and teachers. Several innovative solutions were identified. The enablers were a readiness and rapid response by institutions, with innovation by teachers. The barriers were the lack of planning and resources, usability problems and limited interactivity between teachers and students. CONCLUSIONS: Important and timely evidence was obtained that can inform future policy, practice and research. The findings highlighted the urgent need to use rapid design and implementation methods with greater explicit descriptions in published articles to ensure applicability to other contexts.

Training in healthcare during and after COVID-19: proposal for simulation training.

INTRODUCTION: The challenge of facing COVID-19 falls under all health care structures, and without specific training to health care professionals they are probably the professionals with the highest level of exposure. Regardless of the level of health care, the training of professionals aims to optimize resources and attend patients while assuring quality and security. POINT OF VIEW: This report proposes simulation training for health care professionals to update professionals for attending patients during the pandemic. This training was built with five simulated stations, considering different stages of a patient with COVID-19. This report takes advantage of different simulation techniques, such as skills training, standardized patient, medium- and high-fidelity simulator, rapid cycle of deliberate practice, and in situ simulation. DISCUSSION: Medical procedures for COVID-19 patients offer additional risk for health care professionals, especially considering exposure to procedures that generate aerosols, such as compression, mask ventilation, and orotracheal intubation. Thus, finding educational strategies that allow training is essential to simulate the evolution of COVID-19 patients in a safe manner. CONCLUSION: Simulation has proven to be a useful and effective form of training around the world for training health teams on the front lines for patient care in COVID-19.

Training in healthcare during and after COVID-19: proposal for simulation training

SUMMARY INTRODUCTION: The challenge of facing COVID-19 falls under all health care structures, and without specific training to health care professionals they are probably the professionals with the highest level of exposure. Regardless of the level of health care, the training of professionals aims to optimize resources and attend patients while assuring quality and security. POINT OF VIEW: This report proposes simulation training for health care professionals to update professionals for attending patients during the pandemic. This training was built with five simulated stations, considering different stages of a patient with COVID-19. This report takes advantage of different simulation techniques, such as skills training, standardized patient, medium- and high-fidelity simulator, rapid cycle of deliberate practice, and in situ simulation. DISCUSSION: Medical procedures for COVID-19 patients offer additional risk for health care professionals, especially considering exposure to procedures that generate aerosols, such as compression, mask ventilation, and orotracheal intubation. Thus, finding educational strategies that allow training is essential to simulate the evolution of COVID-19 patients in a safe manner. CONCLUSION: Simulation has proven to be a useful and effective form of training around the world for training health teams on the front lines for patient care in COVID-19.

Clinical simulation strategies for knowledge integration relating to initial critical recognition and management of COVID-19 for use within continuing education and health-related academia in Brazil: a descriptive study

ABSTRACT BACKGROUND: The COVID-19 pandemic has led to an immense need to develop training on case recognition and management, with a focus on patients' and health professionals' safety at several levels of healthcare settings in Brazil. Different simulation strategies can be included in the diverse clinical care phases for these patients. OBJECTIVE: To suggest a complete simulation-based training program for Brazilian hospitals and/or academic institutions at this moment of the pandemic. DESIGN AND SETTING: Descriptive analysis on possible simulated clinical cases using different methodologies, thereby supporting suspected or confirmed COVID-19 patients. METHODS: This was a reflective theoretical descriptive study on an educational program based on clinical simulation, with four practical phases at different performance and complexity levels. Wearing, handling and adequately disposing of personal protective equipment, along with specific respiratory procedures in different healthcare settings up to intensive care for seriously infected patients were addressed. RESULTS: This program was designed for application at different Brazilian healthcare levels through different clinical simulation strategies. Summaries of expected performance were suggested in order to standardize technical capacity within these simulation settings, so as to serve these levels. CONCLUSIONS: Developing training programs for situations such as the current COVID-19 pandemic promotes safety not only for patients but also for healthcare workers. In the present context, clear definition of which patients need hospital outpatient or inpatient care will avoid collapse of the Brazilian healthcare system. Institutions that do not have simulated environments can, through the examples described, adopt procedures to promote didactic information in order to help healthcare professionals during this time.

Clinical simulation strategies for knowledge integration relating to initial critical recognition and management of COVID-19 for use within continuing education and health-related academia in Brazil: a descriptive study.

BACKGROUND: The COVID-19 pandemic has led to an immense need to develop training on case recognition and management, with a focus on patients' and health professionals' safety at several levels of healthcare settings in Brazil. Different simulation strategies can be included in the diverse clinical care phases for these patients. OBJECTIVE: To suggest a complete simulation-based training program for Brazilian hospitals and/or academic institutions at this moment of the pandemic. DESIGN AND SETTING: Descriptive analysis on possible simulated clinical cases using different methodologies, thereby supporting suspected or confirmed COVID-19 patients. METHODS: This was a reflective theoretical descriptive study on an educational program based on clinical simulation, with four practical phases at different performance and complexity levels. Wearing, handling and adequately disposing of personal protective equipment, along with specific respiratory procedures in different healthcare settings up to intensive care for seriously infected patients were addressed. RESULTS: This program was designed for application at different Brazilian healthcare levels through different clinical simulation strategies. Summaries of expected performance were suggested in order to standardize technical capacity within these simulation settings, so as to serve these levels. CONCLUSIONS: Developing training programs for situations such as the current COVID-19 pandemic promotes safety not only for patients but also for healthcare workers. In the present context, clear definition of which patients need hospital outpatient or inpatient care will avoid collapse of the Brazilian healthcare system. Institutions that do not have simulated environments can, through the examples described, adopt procedures to promote didactic information in order to help healthcare professionals during this time.

Fact-checking e saúde: análise da seção 'Verdade ou Boato' de GaúchaZH / Fact-checking and health: an analysis of GaúchaZH's 'Verdade ou Boato' (Truth or Rumor) section / Fact-checking y salud: un análisis de la sección 'Verdade ou Boato' (Verdad o rumor) de GaúchaZH

Este artigo analisa a seção 'Verdade ou Boato', publicada no jornal Zero Hora (meio impresso) e no GaúchaZH (meio digital), com o objetivo de compreender as características das matérias produzidas na seção e o perfil das informações nela checadas; e tensionar como os veículos agenciam sua posição de credibilidade em relação às alterações nos modos de produção e circulação de conteúdos no ambiente digital, especialmente na área temática da saúde. Os procedimentos metodológicos utilizados são as pesquisas bibliográfica e documental e a análise de conteúdo de um corpus composto por 25 matérias. Como resultado, observa-se que a iniciativa de checagem de informações reforça o jornalismo como sistema perito. Entre as características identificadas, destaca-se a adaptação das manchetes para negar informações falsas. Na edição digital, observa-se o pouco uso do potencial que tem o hipertexto para compor uma narrativa sustentada por evidências.

This article analyses the 'Verdade ou Boato' (Truth or Hoax) section, published in the newspaper Zero Hora (printed medium) and in GaúchaZH (digital medium), aiming: to understand the characteristics of the articles published in that section and the profile of information evaluated in it; and to discuss how publishers cope with their position of credibility in the face of the modes of production and circulation of content changes brought by the digital environment, especially with regard to health issues. The bibliographic review and documentary researches and the content analysis of a corpus composed of 25 articles constitute the methodological procedures for analyse them. The result reveals that the fact-checking initiative reinforces journalism as an expert system. Among the characteristics identified, we highlight the adaptation of the headlines to deny false information. In the digital edition one can observe the little use of the potential of hypertext to compose a narrative supported by evidences.

Este artículo analiza la sección 'Verdade ou Boato' (Verdad o Bulo), publicada en el diario Zero Hora (medio impreso) y en GaúchaZH (medio digital) com el objetivo de comprender las características de los artículos publicados en la sección y el perfil de las informaciones chequeadas; y de discutir como los vehículos agencian su posición de credibilidad en relación a los cambios en los modos de producción y circulación de contenidos en el ambiente digital, especialmente en la área temática de la salud. Los procedimientos metodológicos utilizados son las investigaciones bibliográfica y documental y el análisis de contenido de un corpus compuesto por 25 reportajes periódicos. Como resultado, se observa que la iniciativa de chequeo de informaciones refuerza el periodismo como sistema experto. Entre las características identificadas, se destaca la adaptación de los titulares para negar informaciones falsas. En la edición digital, se observa el poco uso del potencial que el hipertexto tiene para componer una narrativa sostenida por evidencias.

Additional simulation training: does it affect students' knowledge acquisition and retention?

Introduction: Teaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging. In this study, we investigated whether adding a simulation training before the clinical rotation would improve students' acquisition and retention of knowledge. Methods: Two subsequent cohorts were compared. Group A followed the traditional curriculum without additional simulation training. Group B attended an additional simulation training, in which history taking, physical examination and procedures for the primary survey in emergency situations were taught. Both groups answered the same knowledge test before entering their clinical rotation and after 6 months. To analyse students' scores over time, we conducted a repeated measure analysis of variance. To investigate the difference between knowledge, we conducted a t-test. Results: Group B scored significantly higher in both tests and all subscores, except in the Trauma topic in the first measurement point. Students in group A showed decay in knowledge whereas group B showed an increase in knowledge. Conclusions: Adding a simulation training, before students entered their clinical rotation, improves students' knowledge acquisition and retention compared with those who did not receive the additional simulation training.

Importância e desafios do treinamento simulado em saúde / Importance and challenges of simulation training in healthcare

O uso da simulação no ensino em saúde amplia as oportunidades de aprendizagem, contribuindo de forma relevante para a prevenção de erros durante a atividade profissional. Entretanto, são vários os desafios para alcançar um treinamento simulado eficiente, incluindo a necessidade de adaptar o conhecimento produzido em diferentes contextos. Como deve ser organizado um centro de simulação? Como levar em conta as peculiaridades dos estudantes na aplicação do conceito de debriefing? Os instrumentos de avaliação foram validados para a população na qual estão sendo aplicados? Quais elementos devem ser incluídos no ensino baseado em simulação para melhorar a aquisição e/ou a retenção de habilidades, conhecimentos e atitudes? Em que momento do currículo introduzir cada possibilidade de treinamento simulado, de modo a tornar o investimento válido? Neste editorial, os autores assinalam a importância do treinamento simulado em saúde e a necessidade de pesquisas que objetivem entender as diferentes situações e fornecer respostas a estas questões.

The use of simulation in health education expands learning opportunities, contributing in a relevant way to the prevention of errors during professional activity. However, there are several challenges to achieving efficient simulated training, including the need to adapt the knowledge produced in different contexts. How should a simulation center be organized? How to take into account the peculiarities of the students in applying the concept of debriefing? Have the evaluation tools been validated for the population in which they are being applied? What elements should be included in simulation-based teaching to improve acquisition and/or retention of skills, knowledge, and attitudes? At what point, in the curriculum, should every possibility of simulated training be introduced in order to make the investment valid? In this editorial, the authors point out the importance of simulation training in healthcare and the need for research aimed at understanding the different situations and providing answers to these questions.

A simulação realística como ferramenta educacional para estudantes de medicina / Realistic simulation as an educacional tool for medical students

Objetivos: A simulação realística faz parte de uma nova possibilidade de ensino que engloba não somente as habilidades técnicas, mas o gerenciamento de crises, liderança, trabalho em equipe e raciocínio clínico que não reflitam prejuízos ao paciente real. O objetivo deste trabalho foi realizar revisão de literatura sobre a utilização da simulação realística, enfatizando a graduação médica e seus aspectos mais relevantes e atuais.Fonte de dados: Foram consultadas as bases de dados PubMed e LILACS, aplicando-se os descritores patient simulation, students, medical e teaching/methods, considerando artigos de revisão publicados nos últimos três anos. Utilizando leitura flutuante dos resumos com a análise de conteúdo e dados registrados, foram encontrados 101 trabalhos de acordo com o propósito desta revisão.Síntese dos dados: Os artigos relatam a importância e auxílio da tecnologia em agregar melhorias ao ensino médico. A segurança do paciente foi descrita como fator decisivo na implementação da simulação realística nas instituições de ensino mundiais. Diversas especialidades foram citadas nos artigos, além de diversos procedimentos específicos e aspectos de exame físico padronizado. Percebe-se interesse em estudar as possíveis formas de avaliar estudantes através dessa ferramenta. As habilidades em comunicação, liderança, tomada de decisão, trabalho em equipe e relacionamento médico/paciente aparecem nesta revisão como o maior benefício de informação aos estudantes.Conclusões: Embora a simulação realística esteja em franco crescimento e valorizada como importante recurso na formação, novos estudos precisam ser realizados e divulgados para fornecer evidências e mensurações concretas e efetivas dessa ferramenta educacional.

Aims: Realistic simulation is part of a new possibility of teaching that encompasses not only the technical skills, but crisis management, leadership, team work, and clinical reasoning that do not reflect actual losses to the real patient. To conduct a review of literature on the use of realistic simulation emphasizing the undergraduate medical education and its most relevant and current aspects.Source of data: PubMed and LILACS databases were consulted, applying the medical subject headings patient simulation, students, medical and teaching/methods, considering articles published in the past three years. Using fluctuating reading of the abstracts with content analysis and recorded data and examination, 101 studies were found in accordance with the purpose of this review.Summary of findings: Articles report the importance and support of technology in aggregating improvements to medical education. Patient safety was described as a decisive factor in the implementation of realistic simulation in institutions worldwide. Various specialties were mentioned among the articles in addition to several specific procedures and aspects of standardized physical examination. There is an interest in studying the possible ways to assess students through realistic simulation. Skills in communication, leadership, decision making, team work and relationship doctor/patient appear in this review as the greatest benefit of information to students.Conclusions: Although realistic simulation is valued and have a rapid growth as an important resource in education, further studies need to be conducted and disseminated to provide concrete and effective evidences and measurements of this educational tool.

Acute effects of stretching exercise on the heart rate variability in subjects with low flexibility levels.

The study investigated the heart rate (HR) and heart rate variability (HRV) before, during, and after stretching exercises performed by subjects with low flexibility levels. Ten men (age: 23 ± 2 years; weight: 82 ± 13 kg; height: 177 ± 5 cm; sit-and-reach: 23 ± 4 cm) had the HR and HRV assessed during 30 minutes at rest, during 3 stretching exercises for the trunk and hamstrings (3 sets of 30 seconds at maximum range of motion), and after 30 minutes postexercise. The HRV was analyzed in the time ('SD of normal NN intervals' [SDNN], 'root mean of the squared sum of successive differences' [RMSSD], 'number of pairs of adjacent RR intervals differing by >50 milliseconds divided by the total of all RR intervals' [PNN50]) and frequency domains ('low-frequency component' [LF], 'high-frequency component' [HF], LF/HF ratio). The HR and SDNN increased during exercise (p < 0.03) and decreased in the postexercise period (p = 0.02). The RMSSD decreased during stretching (p = 0.03) and increased along recovery (p = 0.03). At the end of recovery, HR was lower (p = 0.01), SDNN was higher (p = 0.02), and PNN50 was similar (p = 0.42) to pre-exercise values. The LF increased (p = 0.02) and HF decreased (p = 0.01) while stretching, but after recovery, their values were similar to pre-exercise (p = 0.09 and p = 0.3, respectively). The LF/HF ratio increased during exercise (p = 0.02) and declined during recovery (p = 0.02), albeit remaining higher than at rest (p = 0.03). In conclusion, the parasympathetic activity rapidly increased after stretching, whereas the sympathetic activity increased during exercise and had a slower postexercise reduction. Stretching sessions including multiple exercises and sets acutely changed the sympathovagal balance in subjects with low flexibility, especially enhancing the postexercise vagal modulation.