Getúlio Rodrigues de Oliveira Filho

Introduction: Lumbar puncture is an essential diagnostic and therapeutic procedure, yet novice learners often face limited supervised practice opportunities, especially in resource-constrained settings. Low-cost simulators may expand access to safe procedural training, but require validation before curricular integration. Objective: This prospective study assessed the face, content, and construct validity of a low-cost, 3D-printed lumbar puncture simulator. Methods: Forty-seven participants (13 anesthesiology/neurology physicians; 34 medical students) performed three simulated lumbar punctures following standardized instruction. Performances were video-recorded and evaluated using operational criteria encompassing antiseptic preparation, landmark identification, midline needle technique, stylet handling, and cerebrospinal fluid confirmation; participants also completed post-simulation Likert-based perception surveys. Results: Both groups rated the simulator highly for realism, anatomical fidelity, and educational usefulness (median scores 4-5), demonstrating strong face and content validity. Students exhibited significant reductions in procedure duration across attempts, suggesting improved procedural efficiency, whereas experts performed efficiently throughout. No significant between-group differences in puncture attempts or global performance scores were observed, indicating partial construct validity. Conclusion: This low-cost lumbar puncture simulator demonstrated high perceived realism and educational value and facilitated efficiency gains among novices. Although construct validity was only partially supported, the model represents a feasible, accessible tool for procedural training where commercial simulators are unavailable.

RESUMO Introdução: A punção lombar é um procedimento diagnóstico e terapêutico essencial, mas alunos iniciantes frequentemente têm poucas oportunidades de prática supervisionada, especialmente em contextos com recursos limitados. Simuladores de baixo custo podem ampliar o acesso ao treinamento seguro de procedimentos, mas requerem validação antes de sua integração curricular. Objetivo: Este estudo prospectivo avaliou a validade de face, conteúdo e construto de um simulador de punção lombar de baixo custo, impresso em 3D. Método: Quarenta e sete participantes (13 médicos anestesiologistas/neurologistas; 34 estudantes de medicina) realizaram três punções lombares simuladas após instrução padronizada. As execuções foram gravadas em vídeo e avaliadas com base em critérios operacionais envolvendo preparo antisséptico, identificação de marcos anatômicos, técnica de agulha na linha média, manuseio do mandril e confirmação do líquido cefalorraquidiano; os participantes também completaram questionários de percepção em escala Likert após a simulação. Resultados: Ambos os grupos atribuíram altas pontuações ao simulador quanto ao realismo, fidelidade anatômica e utilidade educacional (medianas 4-5), demonstrando forte validade de face e conteúdo. Estudantes apresentaram reduções significativas no tempo de execução ao longo das tentativas, indicando aquisição de habilidade, enquanto especialistas mantiveram desempenho eficiente em todas as repetições. Não foram observadas diferenças significativas entre os grupos no número de tentativas de punção ou nas pontuações globais de desempenho, indicando validade de construto parcial. Conclusão: O simulador de punção lombar de baixo custo demonstrou alto realismo percebido e valor educacional, além de promover ganhos de eficiência entre iniciantes. Embora a validade de construto tenha sido apenas parcialmente confirmada, o modelo representa uma ferramenta viável e acessível para treinamento procedimental em contextos em que simuladores comerciais não estão disponíveis.

Invasive mechanical ventilation is the ventilatory support technique used in critically ill patients with some type of respiratory failure. The aim of this study was to develop and present sources of validity evidence of a test to assess basic concepts of invasive mechanical ventilation knowledge among physical therapy students. This cross-sectional methodological study of construction and analysis of the sources of validity evidence of a test assessing basic invasive mechanical ventilation knowledge was divided into face and content validation of the test with participation of five expert judges. In order to verify the test usability, a pilot study was carried out with 51 physiotherapy graduation students. In the pilot study, item difficulty index mean and standard deviation, item discrimination index and point-biserial correlation coefficient were 0.46 (SD=0.18), 0.41 (SD= 0.17) and 0.36 (SD=0.16), respectively. In this paper, the basic invasive mechanical ventilation knowledge test preliminary psychometric characteristics were described and showed good preliminary sources of validity evidence through the analysis of face and content validity. Furthermore, the results support the conduct and submission of the test to a refinement in the purpose of exploring the sources of validity evidence through of item internal consistency using Cronbach's Alpha Coefficient and Factor Analysis to obtain stronger sources of validity evidence, so it can be used for evaluation or research. Keywords: Psychometrics. Education. Physical Therapists. Artificial Respiration. Resumo A ventilação mecânica invasiva é a técnica de suporte ventilatório utilizada em pacientes críticos com algum tipo de insuficiência respiratória. O objetivo deste estudo foi desenvolver e apresentar fontes de evidências de validade de um teste para avaliar conceitos básicos de conhecimento sobre ventilação mecânica invasiva entre estudantes de fisioterapia. Este estudo metodológico transversal de construção e análise das fontes de evidências de validade de um teste que avalia o conhecimento básico sobre ventilação mecânica invasiva foi dividido em validação de face e conteúdo do teste com a participação de cinco juízes especialistas. Para verificar a usabilidade do teste, foi realizado um estudo piloto com 51 estudantes de fisioterapia. No estudo piloto, a média e o desvio padrão do índice de dificuldade do item, o índice de discriminação do item e o coeficiente de correlação ponto-bisserial foram 0,46 (DP=0,18), 0,41 (DP=0,17) e 0,36 (DP=0,16), respectivamente. Neste artigo, as características psicométricas preliminares do teste de conhecimento básico sobre ventilação mecânica invasiva foram descritas e mostraram boas fontes preliminares de evidências de validade por meio da análise da validade de face e conteúdo. Além disso, os resultados apoiam a condução e submissão do teste a um refinamento no propósito de explorar as fontes de evidências de validade por meio da consistência interna dos itens usando o Coeficiente Alfa de Cronbach e a Análise Fatorial para obter fontes mais fortes de evidências de validade, para que possa ser usado para avaliação ou pesquisa. Palavras-chave: Psicometria; Fisioterapeutas; Respiração Artificial.

Background Despite considerable study, there is still no consensus defining the ideal compression regimen after ablation of the great saphenous vein with radio frequency or endolaser.

Contexto Apesar dos estudos, a definição do regime de compressão ideal após a ablação da veia safena magna por radiofrequência e por endolaser ainda é controversa.

BACKGROUND: The learning-curve cumulative sum method (LC-CUSUM) and its risk-adjusted form (RA-LC-CUSUM) have been proposed as performance-monitoring methods to assess competency during the learning phase of procedural skills. However, scarce data exist about the method’s accuracy. This study aimed to compare the accuracy of LC-CUSUM forms using historical data consisting of sequences of successes and failures in brachial plexus blocks (BPBs) performed by anesthesia residents. METHODS: Using historical data from 1713 BPB performed by 32 anesthesia residents, individual learning curves were constructed using the LC-CUSUM and RA-LC-CUSUM methods. A multilevel logistic regression model predicted the procedure-specific risk of failure incorporated in the RA-LC-CUSUM calculations. Competency was defined as a maximum 15% cumulative failure rate and was used as the reference for determining the accuracy of both methods. RESULTS: According to the LC-CUSUM method, 22 residents (84.61%) attained competency after a median of 18.5 blocks (interquartile range [IQR], 14–23), while the RA-LC-CUSUM assigned competency to 20 residents (76.92%) after a median of 17.5 blocks (IQR, 14–25, P = .001). The median failure rate at reaching competency was 6.5% (4%–9.75%) under the LC-CUSUM and 6.5% (4%–9%) for the RA-LC-CUSUM method (P = .37). The sensitivity of the LC-CUSUM (85%; 95% confidence interval [CI], 71%–98%) was similar to the RA-LC-CUSUM method (77%; 95% CI, 61%–93%; P = .15). Identical specificity values were found for both methods (67%; 95% CI, 29%–100%, P = 1). CONCLUSIONS: The LC-CUSUM and RA-LC-CUSUM methods were associated with substantial false-positive and false-negative rates. Also, small lower limits for the 95% CIs around the accuracy measures were observed, indicating that the methods may be inaccurate for high-stakes decisions about resident competency at BPBs.

Introduction: Cricothyrotomy is a procedure that may save lives in emergency acute respiratory failure. Cricothyrotomy must be trained during undergraduate medical education, and low-cost simulators may offer a satisfying solution in economical and practical terms. Objective: The aims of this study were to build and assess the face, content, and construct validity of a low-cost, homemade cricothyrotomy simulator developed by the authors. Methods: Forty-seven students and nine surgeons performed three successive simulated cricothyrotomies and answered a face and content validity questionnaire. The construct validity was tested by comparing procedural duration and a global performance score intra- and between groups. Results: Most face and content validity questionnaire items were highly and positively rated, with no difference between the groups. Accordingly, students and surgeons agreed that the simulator resembles a human neck anterior surface, is easy and safe to use, allows the performance of critical steps of the cricothyrotomy, and exhibits potential teaching feasibility. Procedural duration decreased between the first and third attempts among students (mean time decrease = 61.85 s; 95% CI - 41.86 - 81.85; p < 0.001), and a significant difference was found between surgeons’ and students’ performance duration (mean difference = 101.36 seconds [95% CI = 69.08 - 133.64] p < 0.001), suggesting construct validity. The students’ performance scores improved between the first and second attempts (mean difference = 2.25 points; CI 95% = 1.31 - 3.20; p < 0.001). Conclusions: The non-organic, homemade, low-cost cricothyrotomy simulator has acceptable face, content, and construct validity and is suitable for use as a training tool by undergraduate medical students.