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1.
Artigo em Inglês | MEDLINE | ID: mdl-33555146

RESUMO

OBJECTIVE: To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for temporomandibular joints (TMJ, JAMRIS-TMJ). METHODS: An adaptive partial-profile discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank-ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts. RESULTS: Nineteen experts completed the DCE survey and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed non-linear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's rho of 0.92 (intra-quartile range: 0.87-0.95) for the inflammation and 0.93 (0.90-0.94) for the damage domain. CONCLUSIONS: A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.

2.
Expert Rev Clin Immunol ; : 1-11, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33393397

RESUMO

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder, characterized by a relapsing and remitting pattern of disease activity in majority of the patients. Areas covered: This narrative review provides an overview of flare definition, major flare mimics, and the burden of flares in SLE. The authors highlight epidemiology and disease-related risk factor for flares and discuss strategies to reduce flares in SLE. Articles were selected from Pubmed searches conducted between June 2020 and September 2020. Expert opinion: Prolonged clinical remission is observed in approximately 20% of SLE patients flare over the course of the disease. Studies have shown that low disease activity is a good target in SLE, with similar risk of flares, mortality, and quality of life when compared to patients in remission. Clinical and immunological features have shown inconsistent results to identify patients at risk of flares in different cohorts. Cytokine, in serum and urine, has shown promising results to predict flares. However to be useful in clinical practice, they have to be simple, easy, and cost-effective. Future efforts in this direction will allow a more personalized treatment plan for SLE patients, reducing the burden associated with flares.

3.
Expert Rev Clin Immunol ; : 1-7, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33393405

RESUMO

Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic inflammatory condition in childhood. The long-term morbidity, mortality, and quality of life have improved with the earlier use of disease-modifying drugs (DMARDs) and the availability of biology disease-modifying drugs (bDMARDs). Despite the improvement of treatment, around 50% of the patients reach adulthood with articular and/or extra articular disease activity. A careful planned transition from pediatric to adult care is necessary to reduce the loss of follow-up that is associated with stopping medications, flares, and disability due to untreated arthritis or uveitis. Areas covered: This narrative review provides an overview of the importance of transition in JIA Articles were selected from Pubmed searches. Expert opinion: JIA patients, family, and healthcare workers have to be trained to provide an effective transition plan, based on local and national policies. Important aspects such as expectations, maturation, disease characteristics, disease activity, adherence, disability, and psychological aspects among others have to be considered and addressed during the transition phase to improve self-esteem, self-assurance, and quality of life.

4.
Lupus ; : 961203320988586, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509067

RESUMO

Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of "Lupus Investigators" in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.

5.
Semin Arthritis Rheum ; 51(1): 158-165, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33383292

RESUMO

BACKGROUND: Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is an uncommon subtype of peripheral neuropathy (PN) and especially when associated with systemic lupus erythematosus (SLE). There are few reports characterizing PN-associated to SLE, in particular CIDP. This study reviewed the frequency and profile of SLE-related CIDP in our cohort and in the literature and propose a treatment scheme for CIDP associated with SLE. METHOD: We reviewed our database to identify patients with CIDP and SLE. The literature was also reviewed following the guidelines of PRISMA and using the terms "Polyradiculoneuropathy", "Chronic inflammatory demyelinating polyradiculoneuropathy", "CIDP", "Systemic lupus erythematosus", "SLE", "Autoimmune diseases of the nervous system" until December 2019. Selected articles were published in English. RESULTS: We identified 3 patients with SLE and CIDP in our cohort of 1,349 patients with SLE (0.2%). All patients were female, aged between 30 and 44 years and 2 (66.7%) had active disease in other organs. In the literature, we identified additional 16 patients. A predominance of women with disease activity, specially nephritis and hematological involvement, was observed. Treatment schemes are diverse, including corticosteroids and immunosuppressive drugs. CONCLUSION: Although rare, CIDP has increased frequency in SLE. Women and younger age should rise suspicion of an underlying autoimmune disease. We suggest that CIDP should be included as a possible neuropsychiatric manifestation in SLE.

6.
Artigo em Inglês | MEDLINE | ID: mdl-33280020

RESUMO

OBJECTIVE: Sjögren syndrome in children is a poorly understood autoimmune disease. We aimed to describe the clinical and diagnostic features of children diagnosed with Sjögren syndrome and explore how the 2016 ACR/EULAR classification criteria apply to this population. METHODS: An international workgroup retrospectively collected cases of Sjögren syndrome diagnosed under 18 years of age from 23 centres across eight nations. We analysed patterns of symptoms, diagnostic workup, and applied the 2016 ACR/EULAR classification criteria. RESULTS: We identified 300 children with Sjögren syndrome. The majority of patients n = 232 (77%) did not meet 2016 ACR/EULAR classification criteria, but n = 110 (37%) did not have sufficient testing done to even possibly achieve the score necessary to meet criteria. Even among those children with all criteria items tested, only 36% met criteria. The most common non-sicca symptoms were arthralgia [n = 161 (54%)] and parotitis [n = 140 (47%)] with parotitis inversely correlating with age. CONCLUSION: Sjögren syndrome in children can present at any age. Recurrent or persistent parotitis and arthralgias are common symptoms that should prompt clinicians to consider the possibility of Sjögren syndrome. The majority of children diagnosed with Sjögren syndromes did not meet 2016 ACR/EULAR classification criteria. Comprehensive diagnostic testing from the 2016 ACR/EULAR criteria are not universally performed. This may lead to under-recognition and emphasizes a need for further research including creation of paediatric-specific classification criteria.

7.
Pediatr Rheumatol Online J ; 18(1): 87, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176806

RESUMO

BACKGROUND: Concerns about the safety and efficacy of vaccines in patients with autoimmune diseases (AID) have led to contradictions and low vaccination coverage in this population, who are at a higher risk of infections, including by human papillomavirus (HPV). Although HPV vaccines have been recommended for immunocompromised patients, there is still a lack of data to support its use for AID patients, such as juvenile dermatomyositis (JDM) patients. The aim of this study was to assess the safety and immunogenicity of the quadrivalent HPV (qHPV) vaccine in a cohort of JDM patients. METHODS: JDM patients aged from 9 to 20 years and healthy controls (HC) were enrolled to receive a 3-dose schedule of qHPV vaccine from March/2014 to March/2016. Study visits were performed before the first dose, 1 month after the second and third doses, and 6 months after the third dose. Participants completed a diary of possible adverse events for 14 days following each dose of vaccination (AEFV). Disease activity and current therapy were analyzed at each visit for JDM patients. In addition, serum samples from all participants were collected to test antibody concentrations against HPV16 and 18 at each visit. Participant recruitment was conducted in ten Brazilian centres. From 47 eligible JDM patients and 41 HC, 42 and 35, respectively, completed the 3-dose schedule of the vaccine, given that five JDM patients and two HC had received doses prior to their inclusion in the study. RESULTS: The AEFVs presented by the participants were mild and in general did not differ between JDM and HC groups. No severe AEFVs were related to the vaccination. Disease activity was stable, or even improved during the follow-up. One month after the third dose of the vaccine the JDM group presented seropositivity of 100% for HPV16 and 97% for HPV18, similarly to the HC group, who presented 100% for both serotypes (p = 1.000). Six months after the third dose the seropositivity for the patient group was 94% for both HPV types. CONCLUSIONS: The HPV vaccination in this cohort of JDM patients was safe and immunogenic. Since the seropositivity against HPV16 and 18 was very high after the 3-dose schedule, this regimen should be recommended for JDM patients. TRIAL REGISTRATION: Brazilian Clinical Trials Registry, number: RBR-9ypbtf . Registered 20 March 2018 - Retrospectively registered.

8.
Artigo em Inglês | MEDLINE | ID: mdl-33141441

RESUMO

OBJECTIVES: Utilizing data obtained from a prospective international juvenile systemic sclerosis cohort (jSScC) to determine if pulmonary screening with forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) is sufficient to assess the presence of interstitial lung disease (ILD) in comparison to high resolution computed tomography (HRCT) in jSSc. METHODS: The jSScC cohort database was queried for patients enrolled from January 2008 to January 2020 with recorded pulmonary function tests (PFT) parameters and HRCT to determine the discriminatory properties of PFTs parameters, FVC and DLCO, in detecting ILD. RESULTS: Eighty-six jSSc patients had both CT imaging and FVC values for direct comparison. Using findings on HRCT as the standard measure of ILD presence, the sensitivity of FVC in detecting ILD in jSSc was only 40%, the specificity was 77%, and AUC was 0.58. Fifty-eight jSSc patients had both CT imaging and DLCO values for comparison. The sensitivity of DLCO in detecting ILD was 76%, the specificity was 70%, and AUC was 0.73. CONCLUSION: The performance of PFTs in jSSc to detect underlying ILD was quite limited. Specifically, the FVC, which is one of the main clinical parameters in adult SSc to detect and monitor ILD, would miss approximately 60% of children that had ILD changes on their accompanying HRCT. The DLCO was more sensitive in detecting potential abnormalities in HRCT, but with less specificity than the FVC. These results support the use of HRCT in tandem with PFTs for the screening of ILD in jSSc.

9.
Curr Opin Immunol ; 67: 87-94, 2020 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-33246136

RESUMO

Type I interferon (IFN) is a primary pathogenic factor in systemic lupus erythematosus (SLE). Gain-of-function genetic variants in the type I IFN pathway have been associated with risk of disease. Common polygenic as well as rare monogenic influences on type I IFN have been demonstrated, supporting a complex genetic basis for high IFN in many SLE patients. Both SLE-associated autoantibodies and high type I IFN can be observed in the pre-disease state. Patients with SLE and evidence of high type I IFN have more active disease and a greater propensity to nephritis and other severe manifestations. Despite the well-established association between type I IFN and SLE, the specific triggers of type I IFN production, the mechanisms by which IFNs help perpetuate the cycle of autoreactive cells and autoantibody production are not completely clear. This review provides an updated overview of type I IFN in SLE pathogenesis, clinical manifestations, and current therapeutic strategies targeting this pathway.

10.
Lupus ; 29(14): 1873-1884, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33019878

RESUMO

BACKGROUND/PURPOSE: Proton magnetic resonance spectroscopy (1H-MRS) has been shown to be an important non-invasive tool to quantify neuronal loss or damage in the investigation of central nervous system (CNS) disorders. The purpose of this article is to discuss the clinical utility of 1H-MRS in determining CNS involvement in individuals with rheumatic autoimmune diseases. METHODS: This study is a systematic review of the literature, conducted during the month of November and December of 2019 of articles published in the last 16 years (2003-2019). The search for relevant references was done through the exploration of electronic databases (PubMed/Medline and Embase). We searched for studied including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), juvenile idiopathic arthritis, rheumatoid arthritis (RA), psoriasis, Sjögren's syndrome (pSS), vasculitis and Behçet. Only studies published after 2003 and with more than 20 patients were included. RESULTS: We included 26 articles. NAA/Cr ratios were significant lower and Cho/Cr ratios increased in several brain regions in SLE, SS, RA, SSc. Associations with disease activity, inflammatory markers, CNS manifestations and comorbidities was variable across studies and diseases. CONCLUSION: The presence of neurometabolite abnormalities in patients without ouvert CNS manifestations, suggests that systemic inflammation, atherosclerosis or abnormal vascular reactivity may be associated with subclinical CNS manifestations. MRS may be a usefull non-invasive method for screening patients with risk for CNS manifestations.

11.
J Transl Autoimmun ; 3: 100043, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32743524

RESUMO

Childhood-onset systemic lupus erythematosus (cSLE) is a rare, chronic and systemic autoimmune disease generally with a more severe clinical phenotype than the adult-onset SLE. In both conditions, it is known that females are predominantly affected; therefore, the possible overlap of SLE and sex chromosomal abnormalities has attracted attention. Our case report describe the clinical manifestations and immunological profile of a Brazilian female with cSLE and trisomy X. The 22 year-old patient, diagnosed with cSLE at age of 11, present some features related to 47, XXX, such as difficulties at school and communication, although this was not enough to investigate for chromosome abnormalities. Cytoscan HD array screening allowed the comprehensive diagnosis for this patient. We also characterized her ancestral composition, showing that she has 6.2% higher African component than the mean from health subjects from the same geographical area. This report reinforces the role of the X chromosome dose effect for sex bias in SLE, as well as the importance of African ancestry composition in cLES. It also throws lights upon the application of high-throughput molecular analysis in a large scale cohort can be useful to detect the impact of the genomic findings for more accurate epidemiological data.

12.
Rheumatol Int ; 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32813153

RESUMO

Cryopyrin-associated periodic syndromes (CAPS) are a group of autoinflammatory diseases associated with NLRP3 gain of function mutations. CAPS associated mutations are found predominantly in exon 3. The objective of this study is to describe a new variant on NRLP3 gene and its phenotype. Case report description of a new NRLP3 pathogenic variant and literature case-based search through INFEVERS database. A 21-year old male who presented multiple tonic-clonic seizures on his 3rd day of life. At age 2, he had recurrent central facial palsy, high fever (40 °C), painful and persistent oral ulcers, abdominal pain, nausea and vomiting, and delayed neuropsychomotor development, with polyarthritis in wrists and knees. Over the years, several symptoms were observed: livedo reticularis, Raynaud's phenomenon, positive pathergy test, heat allodynia, extremely painful genital ulcers, and sporadic conjunctivitis. Laboratory studies revealed persistently elevated inflammatory markers and serum amyloid protein A (30 µg/l). The genetic panel for autoinflammatory diseases revealed heterozygous mutation in the NLRP3, (c.2068G > C, p.E690Q) with 0% of frequency in the general population. The patient denies rash and did not have frontal bossing or patellar overgrowth. We found a positive familial history on mother and brother, who carried the same mutation. The patient was started on canakinumab which controlled his symptoms. Currently, 241 missense variants in the NLRP3 have been described. We presented a new mutation in exon 3 of the NRLP3 gene in a patient that fulfills clinical criteria for CAPS who had complete clinical response to Canakinumab, supporting the idea that this mutation is pathogenic.

13.
Lupus ; 29(8): 934-942, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501172

RESUMO

OBJECTIVE: This study aimed to assess the safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccination in childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS: Volunteer cSLE patients aged 9-20 years and healthy controls (HC) were enrolled to receive a two- or three-dose qHPV vaccination schedule from March 2014 to March 2016. Study visits were performed before the first dose, one month after the second and third doses and one year after the first dose. In each study visit, disease activity and adverse events following vaccination were analyzed, and a serum sample was collected for testing antibody concentrations. Participant recruitment was conducted in 15 Brazilian paediatric rheumatology units. Of the 256 cSLE patients included, 210 completed the two- or three-dose schedules; 15 had previously received one dose, and 18 had received two doses of the vaccine. The analysis was based on intention-to-treat so that participants who did not complete the entire study protocol were also included. RESULTS: No severe adverse events were related to the vaccination. Disease activity was generally low and remained stable or even improved. The HC presented 100% seropositivity to HPV16 and HPV18, whereas the two- and three-dose cSLE groups presented 93% and 83% versus 97% and 91%, respectively. One year after the first dose, seropositivity of the three-dose cSLE group was 91% to HPV16 and 84% to HPV18. CONCLUSIONS: HPV vaccination in cSLE patients is safe and immunogenic. Since the seropositivity to HPV16 and HPV18 was higher for the three-dose schedule group, this regimen should be recommended for cSLE patients.

16.
J Neurosci Methods ; 334: 108593, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31972183

RESUMO

BACKGROUND: The corpus callosum (CC) is the largest white matter structure in the brain, responsible for the interconnection of the brain hemispheres. Its segmentation is a required preliminary step for any posterior analysis, such as parcellation, registration, and feature extraction. In this context, the quality control (QC) of CC segmentation allows studies on large datasets with no human interaction, and the proper usage of available automated and semi-automated algorithms. NEW METHOD: We propose a framework for QC of CC segmentation based on the shape signature, computed at 49 distinct resolutions. At each resolution, a support vector machine (SVM) classifier was trained, generating 49 individual classifiers. Then, a disagreement metric was used to cluster these individual classifiers. The final ensemble was constructed by selecting one representation from each cluster. RESULTS: The proposed framework achieved an area under the curve (AUC) metric of 98.25% on the test set (207 subjects) employing an ensemble composed of 12 components. This ensemble outperformed all individual classifiers. COMPARISON WITH EXISTING METHODS: To the best of our knowledge, this is the first approach to assess quality of CC segmentations on large datasets without the need for a ground-truth. CONCLUSIONS: The shape descriptor is robust and versatile, describing the segmentation at different resolutions. The selection of classifiers and the disagreement measure lead to an ensemble composed of high-quality and heterogeneous classifiers, ensuring an optimal trade-off between the ensemble size and high AUC.

17.
Mult Scler ; 26(5): 533-539, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31965913

RESUMO

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are two common autoimmune rheumatic diseases that vary in severity, clinical presentation, and disease course between individuals. Molecular and genetic studies of both diseases have identified candidate genes and molecular pathways that are linked to various disease outcomes and treatment responses. Currently, patients can be grouped into molecular subsets in each disease, and these molecular categories should enable precision medicine approaches to be applied in rheumatic diseases. In this article, we will review key lessons learned about disease heterogeneity and molecular characterization in rheumatology, which we hope will lead to personalized therapeutic strategies.

18.
Arthritis Care Res (Hoboken) ; 72(8): 1147-1151, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31127864

RESUMO

OBJECTIVE: To assess the familial occurrence of systemic lupus erythematosus (SLE) in a large Brazilian cohort. METHODS: Consecutive patients with SLE were recruited and stratified according to age at disease onset into childhood-onset SLE or adult-onset SLE. Each patient was personally interviewed regarding the history of SLE across 3 generations (first-, second-, and third-degree relatives). Recurrence rates were analyzed for each degree of relation. RESULTS: We included 392 patients with SLE (112 with childhood-onset SLE and 280 with adult-onset SLE). We identified 2,574 first-degree relatives, 5,490 second-degree relatives, and 6,805 third-degree relatives. In the combined overall SLE cohort, we observed a familial SLE recurrence rate of 19.4 in first-degree relatives, 5.4 in second-degree relatives, and 3.0 in third-degree relatives. Recurrence rates were higher for first- and second-degree relatives of patients with childhood-onset SLE than for first- and second-degree relatives of patients with adult-onset SLE (25.2 versus 18.4 for first-degree, and 8.5 versus 4.5 for second-degree), while in third-degree relatives, recurrence rates were higher in adult-onset SLE than in childhood-onset SLE (P = 2.2 × 10-4 for differences in recurrence proportions between childhood-onset SLE and adult-onset SLE). There were no phenotypic differences in patients from multicase versus single-case families, and there was no sex-skewing observed in the offspring of patients with SLE. CONCLUSION: The greater decline in SLE recurrence rate by generation in childhood-onset SLE versus adult-onset SLE suggests a more polygenic and epistatic inheritance and suggests that adult-onset SLE may be characterized by fewer risk factors that are individually stronger. This finding suggests a higher genetic load in childhood-onset SLE versus adult-onset SLE and a difference in the genetic architecture of the disease based on age at onset.


Assuntos
Predisposição Genética para Doença/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/genética , Adolescente , Adulto , Idade de Início , Idoso , Brasil/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Adulto Jovem
19.
Rev. bras. educ. méd ; 44(supl.1): e155, 2020. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1137575

RESUMO

Resumo: Introdução: Com a suspensão das atividades presenciais e a implementação do ensino remoto do curso de Medicina da Unicamp, foi necessária a elaboração de estratégias para identificar as necessidades dos estudantes para continuidade das aulas nessa nova modalidade. Objetivo: Demonstrar as estratégias desenvolvidas e as soluções encontradas para permitir a equidade de acesso ao ensino remoto no curso de medicina da FCM-Unicamp. Método: São apresentados dados do relatório institucional, elaborado a partir de questionários aplicados para os estudantes do curso de Medicina sobre as dificuldades referentes ao acesso ao ensino remoto emergencial e as ações realizadas para solucionar as principais dificuldades encontradas. Resultados: Constatamos que os anos iniciais do curso apresentam a maior proporção de alunos com dificuldades, embora, em todos os anos, os discentes tenham relatado alguma dificuldade. Os principais problemas identificados foram internet instável e/ou apenas acesso por redes móveis. Verificou-se ainda que os alunos tinham maior dificuldade em acompanhar as atividades síncronas. A maior parte dos alunos mencionou que acompanhava as aulas por computadores e notebooks, mas, muitas vezes, estes eram compartilhados com outros membros da família. Alguns estudantes apontaram também que muitas vezes, não conseguiam acompanhar o curso por falta de aparelhos ou acesso à internet. Nesse caso, computadores e chips de celular e para uso em tablets eram emprestados aos alunos. Houve orientação aos professores para adequação das ferramentas pedagógicas utilizadas. Conclusão: Garantir a equidade de acesso é fundamental para permitir a continuidade dos estudos na transformação do estudo presencial em remoto emergencial. O ato de escutar os alunos sobre as dificuldades em relação ao ensino remoto e a realização de suporte material são ferramentas essenciais para o sucesso dessa estratégia pedagógica. A orientação do corpo docente em relação às dificuldades dos alunos foi importante para adequação do ensino remoto. Essas ações auxiliaram os estudantes na mudança do ensino imposta pelo distanciamento social.


Abstract: Introduction: After the implementation of remote teaching for the academic activities of the Medicine course at UNICAMP, due to the COVID Pandemic, a new strategy was required to identify the needs of students to allow them to keep up with the course in this new pedagogical modality. Objective: To demonstrate the strategies developed and solutions found to allow for equal access to remote education in the medical course at FCM-UNICAMP. Method: We present data from our institutional report based on questionnaires completed by medical students regarding the difficulties related to access to emergency remote education and the actions taken to solve the main difficulties encountered. Results: We identified that the initial years of the course had the highest proportion of students with difficulties, although all students reported some difficulty. The main problems identified were unstable internet and/or only access via mobile networks, and the most significant difficulty was in accessing the synchronous activities. Most students reported attending classes via computer and notebooks, but this device was often shared with other family members, most notably during the pandemic. Thirty-one students reported difficulties that prevented them from following the course adequately due to lack of devices or internet access. One solution was computers and cell phone chips and tablets being loaned out to students. Teachers were instructed to adapt the pedagogical tools used. Conclusion: Ensuring equal access is essential to support studies to continue following the transition from face-to-face classes to emergency remote study. Listening to students about the difficulties concerning remote teaching is an essential tool for the success of this pedagogical strategy. Guidance of the teaching staff in relation to the difficulties encountered by students was important for the adequacy of remote teaching. These actions helped students in the change of teaching imposed by social distancing.

20.
Rev. bras. educ. méd ; 44(1): e022, 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1092501

RESUMO

Abstract: Introduction: Program assessment is the process of data collection about a course or teaching program that takes into consideration the aspects of cost-effectiveness, checking the adequacy of the evaluation according to the course purpose and the program capacity to yield changes in real life. Such regular assessments provide feedback to the decision-making process that aim at better teaching and learning practices. The Mini Clinical Evaluation Exercise (MiniCex) is a performance rating scale designed to assess the skills that medical students and residents need in real-life situations with patients. Considering the importance of program assessment for an institution, the utilization of the MiniCex data might be of great value for the follow-up of students and the course, helping the planning process and generating improvements in the institution. Therefore, the objective of this study is to assess the program using MiniCex in the beginning of the medical internship, aiming to determine in what areas of the basic and pre-clinical course the students have more difficulties. Methods: A cross-sectional descriptive study was carried out, using the retrospective data obtained by the MiniCex forms that were applied to the 9th-semester medical students, which correspond to the first semester of medical internship in the Federal University of Pará. A total of 111 students was assessed, among the 154 students eligible for internship, from August 2017 to July 2018. Results: Among the performed evaluations, with 97% being requested by the teachers, most of them (72%) were about new cases, and 45% and 38% had low or moderate complexity, respectively. There was a predominance of musculoskeletal system disorders (27.7%), followed by the gastrointestinal/hepatology system (14.8%). Concerning the skills in each domain, the performance was satisfactory in all of them. We observed that 12% of the students had difficulties in at least one area, followed by 6.3% of students with difficulties in 2 areas and 4.5% with an unsatisfactory performance in 3 or more areas. Conclusion: the MiniCex, when applied to internship students, showed to be a source of important and useful information, as part of a program assessment concerning the areas preceding the internship. The analysis of the obtained data was sent to teachers of the pre-internship, internship and course management areas. To the first ones, with the objective of reviewing their programs, detecting where they can intervene and, thus, make changes that aim a better acquisition of basic knowledge by the students and, consequently, improve their performance. To the second ones, to provide an overview of where they will have to focus their programs according to the needs of the medical students who reach the internship. Finally, to the course management, as a guide of what should be supervised by the professionals teaching the semesters that precede the internship.


Resumo: Introdução: avaliação de programa é o processo de obtenção de informações sobre um curso ou programa de ensino que leva em consideração aspectos de custo-efetividade, de checagem da adequação da avaliação ao propósito do curso e da capacidade do programa de induzir transformação da realidade. Tais avaliações regulares retroalimentam as tomadas de decisão que almejam melhores práticas de ensino e aprendizagem. O Miniexecício Clínico Avaliativo (Mini Clinical Evaluation Exercise - MiniCex) é uma escala de classificação de desempenho projetada para avaliar as habilidades que os acadêmicos e residentes necessitam em encontros reais com os pacientes. Diante da importância da avaliação de programa para uma instituição, a utilização de dados do MiniCex pode ser de grande valia para o acompanhamento dos alunos e do curso, favorecendo o planejamento e as melhorias na instituição. Objetivo: utilizar o MiniCex como parte de uma avaliação de programa no início do internato do curso de Medicina, visando determinar as áreas do curso básico e pré-clínico nas quais o aluno possui deficiências. Métodos: Foi realizado um estudo transversal, de caráter descritivo, com a utilização de dados retrospectivos obtidos por meio das fichas do MiniCex aplicadas aos alunos do nono semestre no módulo de Clínica Médica que correspondeu ao primeiro semestre do internato da Faculdade de Medicina da Universidade Federal do Pará, sendo avaliados um total de 111 alunos dentre os 154 aptos ao internato no período de agosto de 2017 a julho de 2018. Resultados: Dentre as avaliações realizadas, com 97,2% solicitadas pelos professores, a maioria (72%) foi de casos novos, 45% e 38,7% de baixa e moderada complexidade, respectivamente. Houve predomínio afecções do sistema musculoesquelético (27,7%), seguido do sistema gastrointestinal/hepatologia (14,8%). Quanto às habilidades em cada domínio, obteve-se rendimento suficiente em todos. Observou-se que 12,6% dos alunos tiveram deficiência em pelo menos uma área, o que foi seguido de 6,3% de alunos insuficientes em duas áreas e 4,5% com rendimento insatisfatório em três ou mais áreas. Conclusão: o MiniCex aplicado aos estudantes do internato mostrou-se capaz de fornecer informações importantes e úteis como parte de uma avaliação de programa das áreas prévias ao internato. A análise dos dados obtidos foi encaminhada aos professores do pré-internato e do internato e à direção do curso. Enviou-se a análise aos primeiros para que pudessem rever seus programas e detectar em que ponto podem intervir e fazer as alterações que visem à melhor aquisição de conhecimentos básicos pelos discentes e consequentemente ao aumento do desempenho deles. Quanto aos professores do internato, o objetivo foi apresentar-lhes um panorama dos aspectos em que precisarão concentrar seus programas conforme as carências indicadas pelos acadêmicos que chegam ao internato. Por último, à direção, o material serviu de guia do que deve fiscalizar dos docentes dos semestres que antecedem o internato.


Resumo: Introdução: avaliação de programa é o processo de obtenção de informações sobre um curso ou programa de ensino que leva em consideração aspectos de custo-efetividade, de checagem da adequação da avaliação ao propósito do curso e da capacidade do programa de induzir transformação da realidade. Tais avaliações regulares retroalimentam as tomadas de decisão que almejam melhores práticas de ensino e aprendizagem. O Miniexecício Clínico Avaliativo (Mini Clinical Evaluation Exercise - MiniCex) é uma escala de classificação de desempenho projetada para avaliar as habilidades que os acadêmicos e residentes necessitam em encontros reais com os pacientes. Diante da importância da avaliação de programa para uma instituição, a utilização de dados do MiniCex pode ser de grande valia para o acompanhamento dos alunos e do curso, favorecendo o planejamento e as melhorias na instituição. Objetivo: utilizar o MiniCex como parte de uma avaliação de programa no início do internato do curso de Medicina, visando determinar as áreas do curso básico e pré-clínico nas quais o aluno possui deficiências. Métodos: Foi realizado um estudo transversal, de caráter descritivo, com a utilização de dados retrospectivos obtidos por meio das fichas do MiniCex aplicadas aos alunos do nono semestre no módulo de Clínica Médica que correspondeu ao primeiro semestre do internato da Faculdade de Medicina da Universidade Federal do Pará, sendo avaliados um total de 111 alunos dentre os 154 aptos ao internato no período de agosto de 2017 a julho de 2018. Resultados: Dentre as avaliações realizadas, com 97,2% solicitadas pelos professores, a maioria (72%) foi de casos novos, 45% e 38,7% de baixa e moderada complexidade, respectivamente. Houve predomínio afecções do sistema musculoesquelético (27,7%), seguido do sistema gastrointestinal/hepatologia (14,8%). Quanto às habilidades em cada domínio, obteve-se rendimento suficiente em todos. Observou-se que 12,6% dos alunos tiveram deficiência em pelo menos uma área, o que foi seguido de 6,3% de alunos insuficientes em duas áreas e 4,5% com rendimento insatisfatório em três ou mais áreas. Conclusão: o MiniCex aplicado aos estudantes do internato mostrou-se capaz de fornecer informações importantes e úteis como parte de uma avaliação de programa das áreas prévias ao internato. A análise dos dados obtidos foi encaminhada aos professores do pré-internato e do internato e à direção do curso. Enviou-se a análise aos primeiros para que pudessem rever seus programas e detectar em que ponto podem intervir e fazer as alterações que visem à melhor aquisição de conhecimentos básicos pelos discentes e consequentemente ao aumento do desempenho deles. Quanto aos professores do internato, o objetivo foi apresentar-lhes um panorama dos aspectos em que precisarão concentrar seus programas conforme as carências indicadas pelos acadêmicos que chegam ao internato. Por último, à direção, o material serviu de guia do que deve fiscalizar dos docentes dos semestres que antecedem o internato.

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