Rafael Oliveira Chaves

Os elevados custos de hospitalização para o tratamento de doenças ressaltam a importância da abordagem precoce de tumores e outras patologias dermatológicas. A demora no atendimento agrava o quadro clínico e, consequentemente, aumenta os custos para o Sistema Único de Saúde (SUS) do Brasil. Objetiva-se descrever a experiência de implantação do Ambulatório de Pequenas Cirurgias Dermatológicas no Centro de Especialidades Médicas e Odontológicas de Belém/Pará (CEMO), uma unidade de atenção secundária do SUS. A implantação do ambulatório foi realizada principalmente com a utilização dos recursos humanos e da infraestrutura já existentes no centro de atendimento. Além disso, foi elaborado um protocolo e um fluxo de atendimento para a realização de biópsias de pele com finalidade diagnóstica, aplicação de medicamentos intradérmicos, tratamento de afecções ungueais cirúrgicas e manejo de cânceres de pele ou outros tumores em estágio inicial. A criação do ambulatório permitiu a redução da demanda cirúrgica dermatológica, a diminuição do tempo de espera para o tratamento de determinadas doenças dermatológicas e a redução dos custos associados à hospitalização no nível de atenção terciária do SUS. Portanto, o Ambulatório de Pequenas Cirurgias Dermatológicas mostrou-se uma estratégia eficaz para melhorar a assistência dermatológica no sistema público de saúde, favorecendo o diagnóstico precoce e otimizando o uso dos recursos.

Objetivo:Descrever as contribuições de enfermagem sobre a prevenção, triagem e controle do vírus linfotrópico de células T humana-HTLV. Método: Trata-se de uma pesquisa de carácter qualitativa com abordagem exploratória e descritiva, através de pesquisa de campo realizado em todas as UBS – Unidades Básicas de Saúde do município de Augustinópolis. Resultado: Observou que 66,8% não conhece as formas de prevenção para o vírus, 89,1% não trabalha ação sobre vírus linfotrópico de células T humanas nas UBS, 77,8% respondeu que não existe programa atualmente desenvolvido pelo Ministério da Saúde que realiza triagem do vírus e 88,9% não souberam responder quais seriam as orientações para as portadoras do vírus gravidas. Conclusão:Os enfermeiros atuantes no município de Augustinópolis não trabalharam ações sobre o vírus nas Unidades básicas de saúde, no entanto a pesquisa colabora para o aumento da literatura científica sobre o assunto para contribuir na inserção da temática entre os profissionais de enfermagem do município.

Introduction: The Red Reflex Test (RRT) consists of visualizing the reflection that light causes in the retina when it passes through the pupil. It is a screening test for pathologies that can lead to blindness, which still have great social and economic impact on families and the government. Teaching through simulators allows students and health professionals to acquire and improve their clinical skills. Objective: The aim of the study is to develop a low-cost dummy, 3D printed and based on the Arduino platform, for the training of the red reflex technique (RRT) in newborns and evaluate its educational effectiveness. Method: A RRT dummy was presented to 7 expert judges: 6 pediatricians and 1 ophthalmologist to evaluate its applicability in medical learning. For this purpose, they used a 14-item Likert scale of 5 points. Subsequently, 40 individuals participated in a course: 33 medical students, 5 pediatric residents, a nurse and a general physician. The participants were randomly assigned to two groups: control (CG) and experimental (EG) group. Each group consisted of 20 participants. The EG went through 4 stages: 1) theoretical background; 2) handling of the simulator; 3) simulated clinical practice and; 4) evaluation in real-life patients. Whereas the CG went through the following teaching methodological processes: 1) theoretical background; 2) direct training in real-life patients and; 4) practical evaluation in a real-life patient. After each respective group intervention, both groups were assessed on their learning in 40 newborns at Santa Casa de Misericórdia do Pará Foundation in Belém, state of Pará, Brazil. Results: At the judges’ evaluation regarding the simulator positive items (design, similarity, interest, relevance, content, memorization, didactics, previous reminiscence, comprehension and application), 49.2% answered ‘strongly agree’ and 44.4%, ‘agree’. Regarding the negative questions (difficulty in understanding, information overload, abstraction, difficulty in handling and clarity of operation), 40.0% answered ‘strongly disagree’, and 57.1%, ‘disagree’. The judges were 94.9% favorable to the use of the simulator in medical education. However, comparing the two groups of students, regarding the time of exam, the results showed no statistically significant difference (p-value = 0.29). Conclusions: The dummy showed its applicability for the learning of RRT, with the advantage of being able to perform the exam without having to disturb a real-life patient.

In organizations that are seeking a high degree of maturity, it is necessary to achieve a statistical control of software processes and to know their behavior and operational performance. The approach adopted for the research involves reading articles and experience performance reports, practical cases, discussion, the use of games and simulators, practical projects, and reflection by students on the knowledge learned and activities carried out. The evaluation was conducted with undergraduates enrolled in a Computer Science Bachelor's degree programme, who were divided into a control group and an experimental group. At the end, the two groups carried out a practical project to evaluate the learning effectiveness reached by the students. The results of the study suggest that there was a difference in the effectiveness of the learning resulting from the teaching approach and traditional instruction. The authors observed a mean gain of 30.06% in the experimental group, which is evidence of this rise in the learning effectiveness.

Surgical training using 3D virtual reality simulators has become an important routine in medical education. Recent research points to Leap Motion as an exciting interface for the control of virtual surgical instruments due to its simplicity and low-cost characteristics. However, previous studies using Leap Motion only evaluated movements of the whole hand, without considering individual finger movements during the manipulation of surgical instruments. This work investigates the use of Leap Motion as an interface for the capture of basic hand and finger movements during a simulated hysteroscopy using a 3D-printed hysteroscope model. We created a virtual simulated uterine environment containing a hysteroscope controlled by movements of the hand and fingers of a user actuating on a 3D-printed model hysteroscope. The model hysteroscope was positioned in a pivot basis allowing the capture of the following basic movements: leftward/rightward, upward/downward, forward/backward, and extrusion/retraction of the virtual resection loop (which rests on the end of the virtual virtual resectoscope). The findings indicate that the arc-shaped paths of the hysteroscope’s alpha plane (rightward/leftward) and beta plane (upward/downward) movements are satisfactorily simulated by the virtual reality system. Using Intraclass Correlation, was noted that the similarity between the calculated (ideal standard) and measured arcs was highly significant on both planes (r = 0.9599 on the alpha plane, and r = 0.9208 on the beta plane). Also, the forward/backward trajectory is a straight line; the pinch gesture decreases its accuracy when increase its distance from the Interaction Box of Leap Motion. The results were satisfactorily since compared with previous works, which used Leap Motion for the capture of hands-free gesturing.

Introduction Games are recognized tools that can be used for teaching, awareness-building and behavioral change. In the world of competitive sports, it is necessary to both educate athletes and make them aware that doping is an unsportsmanlike practice, particularly because this conduct can be life-threatening. A game called “Heart at Risk” was developed in this context for the purpose of teaching athletes which substances are characterized as doping by the World Antidoping Agency, and to raise their awareness of health hazards through entertainment. Objective Present and empirically evaluate the efficacy of the game as a tool for educating athletes on substances characterized as doping. Methods The sample group was formed by 20 players in the under-20 category of Clube do Remo (Rowing Club), aged over 18 years. The athletes underwent a pre-test, played the Heart at Risk game, and took a post-test at the end. Both tests were related to healthy sport practices (positive factors) and to doping substances (negative factors). Results Regarding the knowledge of positive factors, there was an increase of knowledge in relation to low doses of caffeine (∆ = 40%; p-value= 0.0125) and doping assessment (∆ = 55%; p-value = 0.0017). Regarding negative factors, there was an increase of knowledge in relation to diuretics (∆ = 25%; p-value = 0.0455), contaminated thermogenic (∆ = 35%; p-value = 0.0191), growth hormone-GH (∆ = 50%; p-value = 0.0025), contaminated supplements (∆ = 65%; p-value = 0.0007), and testosterone (∆ = 55%; p-value = 0.0017). Conclusion The Heart at Risk game proved to be an effective resource in the process of learning about prohibited substances and positive factors for sports performance. Level of Evidence IV; Case series.

Background: Caring for leprosy patients requires neurological assessment for prevention of potential physical disabilities. This study focused on the neurological impairment and degree of physical incapacity (DI) at the time of the diagnosis and at discharge of leprosy patients from Dermatology Department of the University of the State of Pará. Methods and findings: It was a cross-sectional, observational study based on the medical records, neurological assessment and DI of 14 patients assisted at a referral service between 2012 and 2016, applying descriptive statistical analysis. At diagnosis were observed patients with decreased abduction forces of the 5th finger (14.28%), extension of hallux and foot dorsiflexion (10.72%); loss of protective sensitivity in the ulnar nerve area (3.57%) and tibial nerve area (25%); 7.15% of thickened ulnar nerve; DI 0 (64.28%) and DI 1 (35.72%). At discharge, 10.72% of the patients showed decreased abduction of the 5th finger, extension of hallux and foot dorsiflexion (14.28%); loss of protective sensitivity just in the tibial nerve area (17.87%); 4.28% of thickened ulnar nerve; DI 0 (78.57%) and DI 1 (21.43%). Conclusions: Therefore, most of the patients had normal neurological assessment and DI 0 at both moments, with reduction of alterations in discharge, except for the fibular nerve. Thus, it is highlighted the primary role of the health team, which constitutes one of the main agents promoters of health education, especially when it comes to preventing disabilities in leprosy.

Background. The electrocardiogram (ECG) is the most used diagnostic tool in medicine; in this sense, it is essential that medical undergraduates learn how to interpret it correctly while they are still on training. Naturally, they go through classic learning (e.g., lectures and speeches). However, they are not often efficiently trained in analyzing ECG results. In this regard, methodologies such as other educational support tools in medical practice, such as educational software, should be considered a valuable approach for medical training purposes. Methods. We performed a literature review in six electronic databases, considering studies published before April 2017. The resulting set comprises 2,467 studies. From this collection, 12 studies have been selected, initially, whereby we carried out a snowballing process to identify other relevant studies through the reference lists of these studies, resulting in five relevant studies, making up a total of 17 articles that passed all stages and criteria. Results. The results show that 52.9% of software types were tutorial and 58.8% were designed to be run locally on a computer. The subjects were discussed together with a greater focus on the teaching of electrophysiology and/or cardiac physiology, identifying patterns of ECG and/or arrhythmias. Conclusions. We found positive results with the introduction of educational software for ECG teaching. However, there is a clear need for using higher quality research methodologies and the inclusion of appropriate controls, in order to obtain more precise conclusions about how beneficial the inclusion of such tools can be for the practices of ECG interpretation.

Purpose: In order to engage medical students and residents from public health centers to utilize the telemedicine features of surgery on their own smartphones and tablets as an educational tool, an innovative streaming system was developed with the purpose of streaming live footage from open surgeries to smartphones and tablets, allowing the visualization of the surgical field from the surgeon’s perspective. The current study aims to describe the results of an evaluation on level 1 of Kirkpatrick’s Model for Evaluation of the streaming system usage during gynecological surgeries, based on the perception of medical students and gynecology residents. Methods: Consisted of a live video streaming (from the surgeon’s point of view) of gynecological surgeries for smartphones and tablets, one for each volunteer. The volunteers were able to connect to the local wireless network, created by the streaming system, through an access password and watch the video transmission on a web browser on their smartphones. Then, they answered a Likert-type questionnaire containing 14 items about the educational applicability of the streaming system, as well as comparing it to watching an in loco procedure. This study is formally approved by the local ethics commission (Certificate No. 53175915.7.0000.5171/2016). Results: Twenty-one volunteers participated, totalizing 294 items answered, in which 94.2% were in agreement with the items affirmative, 4.1% were neutral, and only 1.7% answers corresponded to negative impressions. Cronbach’s α was .82, which represents a good reliability level. Spearman’s coefficients were highly significant in 4 comparisons and moderately significant in the other 20 comparisons. Conclusions: This study presents a local streaming video system of live surgeries to smartphones and tablets and shows its educational utility, low cost, and simple usage, which offers convenience and satisfactory image resolution, thus being potentially applicable in surgical teaching.

O objetivo deste artigo é identificar os Fatores Críticos de Sucesso (FCS) de cursos de graduação em Computação na ótica dos alunos. Os FCS foram pesquisados e agrupados em quatro categorias: Instituição, Docente, Aluno e Serviços de Apoio da Instituição. Cada categoria é composta de vários indicadores. Utilizou-se o questionário Likert de cinco pontos para gerar descrições quantitativas. Participaram da pesquisa 284 alunos de duas universidades federais da Amazônia. Os resultados foram determinados pela análise estatística dos itens Likert em cada categoria. A confiabilidade do questionário foi de 0,975 segundo o coeficiente alpha de Cronbach. Os resultados apontaram que o FCS mais relevante foi o FCS Docente.