Arnaldo Aires Peixoto Junior

Chylopericardium, the accumulation of chyle within the pericardial space, is a rare complication of cardiothoracic surgery. We report a 63-year-old woman who developed chylopericardium about 7 weeks after left ventricular aneurysmectomy and coronary artery bypass grafting. She presented with dyspnoea and abdominal pain. Chest computed tomography showed a large pericardial effusion with right-chamber compression. Emergency pericardial drainage yielded 1000 mL of milky fluid with a triglyceride concentration of 535 mg/dL and a lymphocytic predominance. The pericardial fluid culture grew Staphylococcus epidermidis from a single sample; blood cultures were negative, and vancomycin was continued for 4 weeks, although contamination could not be excluded. Doppler ultrasound showed thrombosis at the left jugulo-subclavian junction, where the Thoracic duct drains, and anticoagulation was started. Oral intake was suspended and total parenteral nutrition was given. Drainage fell and turned citrine, then became chylous again at low volume once an oral diet was reintroduced. Thoracic duct ligation and a pleuropericardial window, performed thoracoscopically, achieved definitive control, and the effusion had resolved completely by 5 months. This case shows that a low-volume chylous relapse can indicate the need for surgical ligation once conservative measures have been tried.

Objective: To develop and evaluate TELAPSI, a freely accessible bilingual digital learning object that supports faculty in teaching about schizophrenia through curated cinematic scenes linked to psychopathological descriptions and structured lesson plans. Methods: A methodological study with a quantitative and qualitative approach was conducted in three sequential phases: intentional film selection, platform development, and evaluation by a panel of 20 experts (10 psychiatrists and 10 health educators). Content was assessed with the Brazilian-validated Learning Object Review Instrument (LORI) and usability with the System Usability Scale (SUS); groups were compared using the Mann–Whitney test and Welch’s t-test, and open-ended responses were examined through descriptive qualitative analysis. Results: Median LORI domain scores ranged from 4.40 to 4.90 (1–5 scale), with content quality, motivation, and usability and interaction rated highest. Significant differences between groups appeared only in usability and interaction ( p = 0.034) and accessibility ( p = 0.009), with health educators scoring higher than psychiatrists. The mean SUS score was 90.4 (95% confidence interval [CI] 86.1–94.7), classified as excellent, again higher among health educators (95.5 vs. 85.3; p = 0.010; Cohen’s d = 1.33). Qualitative analysis identified three themes: usability and user experience; pedagogical relevance and innovation; and suggestions for improvement and expansion. Conclusion: TELAPSI achieved high expert-rated quality as a digital learning object and excellent usability, providing a transferable model for film-based teaching in psychiatric education. These findings establish its content validity and usability as the validation phase preceding controlled studies of learner outcomes.

Recent advances in Alzheimer's disease (AD) biomarkers and genomics have raised interest in personalized approaches to related conditions such as postoperative delirium (POD). Chen et al. report a moderate association between AD polygenic risk scores (AD-PRS) and POD, suggesting genetic susceptibility as a marker of biological vulnerability. However, the clinical utility of AD-PRS remains uncertain, as the study does not demonstrate incremental predictive value over established clinical risk factors. At present, AD-PRS should be considered a research tool. Future studies should assess its predictive performance, cost-effectiveness, and ethical implementation in diverse populations.

While Bloom's Taxonomy is essential for developing higher-order clinical reasoning, its practical application by faculty remains limited. This perpetuates a reliance on assessments that favor memorization over clinical reasoning. This study aimed to develop and validate a Generative AI tool to assist educators in accurately classifying assessment items, and to evaluate the tool's impact on medical faculty's classification accuracy. A two-phase experimental design was used. Phase 1 involved training and validating a ChatGPT-4 model using 200 medical exam items classified by a panel who established a "gold standard". The model's performance was then tested on an independent set of 100 items and assessed using overall accuracy, Cohen's Kappa, and Matthews Correlation Coefficient (MCC). Phase 2 involved experienced medical professors using the validated AI tool. In Phase 1, the AI model achieved a high overall accuracy of 95.0% (95% CI: 90.0-99.0%) and "very good" inter-rater agreement with the expert standard (K = 0.85). In Phase 2, faculty demonstrated high overall adherence (75.2%) to the AI's recommendations. In cases of disagreement where faculty chose to override the AI, the faculty's final decision was accurate only 29.4% of the time, demonstrating human overconfidence. Generative AI, despite a specific and predictable flaw in differentiating "Analyze" from "Understand," serves as a powerful partner for medical faculty. The tool provides a more reliable classification than un-aided, non-expert human judgment. It can significantly improve assessment validity by supporting faculty, helping to bridge pedagogical training gaps, and promoting the development of assessments that target higher-order cognitive skills essential for medical practice.

Introduction: Medical education still shows significant gaps in nutritional therapy training, despite the proven impact of clinical nutrition on patient outcomes. Experience report: Since 2013, the program has offered an additional optional year for physicians previously trained in related specialties, emphasizing supervised clinical practice, participation in multidisciplinary nutrition support teams (EMTN), and management of enteral and parenteral nutrition. To date, nine physicians have completed the residency; three have earned the Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE/Braspen) certification, others are in progress, and all are currently involved in clinical practice and teaching within public and private hospitals. Discussion: The experience gained by the HUWC/UFC Medical Residency Program in Parenteral and Enteral Nutrition demonstrates the importance of incorporating formal training in nutritional therapy into advanced medical education. The model reported represents an innovative institutional response, integrating practical learning in EMTN into the routine of hospital care. The results observed, with a high rate of professional certification and placement in preceptorship and management positions, suggest a positive impact of the program on the consolidation of clinical nutrition as a strategic area in the health system. Conclusion: The HUWC/UFC experience demonstrates that a residency focused on clinical nutrition is a feasible and effective strategy for integrating education and healthcare, strengthening nutrition support teams, and improving the quality of hospital nutritional care.

RESUMO Introdução: A formação médica ainda apresenta lacunas no ensino da terapia nutricional, apesar do impacto da nutrição clínica sobre os desfechos de pacientes hospitalizados. Relato de experiência: Desde 2013, o programa oferece um ano adicional opcional para médicos previamente especialistas em áreas afins, com atuação em equipe multiprofissional de terapia nutricional (EMTN) e ênfase em prática clínica supervisionada, manejo de nutrição enteral e parenteral e atividades teórico-científicas. Até o momento, nove médicos concluíram a residência; três obtiveram o título de especialista pela Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE/Braspen), outros seguem com esse propósito, e todos estão envolvidos, entre hospitais públicos e privados, com o ensino e a assistência em nutrição clínica. Discussão: A experiência acumulada pelo Programa de Residência Médica em Nutrição Parenteral e Enteral do HUWC/UFC demonstra a relevância de incorporar o treinamento formal em terapia nutricional à formação médica avançada. O modelo relatado representa uma resposta institucional inovadora ao integrar o aprendizado prático em EMTN à rotina de cuidado hospitalar. Os resultados observados, com elevada taxa de busca por certificação profissional e inserção em cargos de preceptoria e gestão, sugerem impacto positivo do programa na consolidação da nutrição clínica como área estratégica no sistema de saúde. Conclusão: A experiência do HUWC/UFC evidencia que a residência médica voltada à nutrição clínica é uma estratégia viável e eficaz de integração ensino-serviço, capaz de qualificar profissionais, fortalecer as EMTN e aprimorar a qualidade do cuidado nutricional hospitalar.

A Parada Cardiorrespiratória (PCR) é uma emergência médica grave, e a aplicação eficaz do Suporte Básico de Vida (SBV) pode aumentar significativamente as chances de sobrevivência das vítimas. No entanto, há uma lacuna na capacitação da população leiga em SBV. Portanto, é essencial promover programas educacionais para trabalhadores de áreas com grande fluxo de pessoas predispostas a essa emergência. Torna-se oportuno, nesse cenário, integrar extensão universitária, ensino e comunidade. Capacitar trabalhadores de hospitais universitários federais em SBV por meio de aulas teóricas e práticas com simulação in situ, promovendo a interação entre extensão universitária, ensino e comunidade, a fim de melhorar a resposta a situações de PCR e aumentar as chances de sobrevivência das vítimas. O estudo envolveu aulas teóricas e práticas com simulação in situ para servidores administrativos de dois hospitais universitários federais. As aulas foram ministradas por estudantes de medicina sob supervisão direta, seguidas de avaliação por questionário de satisfação. Participaram 136 servidores, e 58 (42,6%) responderam ao questionário. Quanto à capacitação promovida pelo projeto de extensão, a maioria assinalou “concordo totalmente” em todos os itens avaliados. O estudo demonstrou alto grau de satisfação com a ação, confirmando a relevância dos programas de extensão universitária na melhoria da sociedade, promovendo atividades educacionais, bem-estar e preparando a comunidade para emergências em saúde.

Introduction: Various works of literature, plastic arts, music, and cinema portray common health problems. Cinema makes it possible to discuss psychiatric issues in an accessible and engaging way by dramatising complex human experiences. In cinema, the representation of protagonists with psychiatric illnesses, behavioural disorders, personality disorders, or substance abuse is common. The use of these productions for teaching psychiatry has been increasingly reported in the literature. However, the appropriate strategy for incorporating films into teaching practice and the assessment of the teaching-learning process is are bottleneck in the dissemination of this practice. Aims: The aim of this scoping review is to address the question: “What do we know about teaching strategies in psychiatry using film?”. Methods: This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. The search was carried out in the MEDLINE, Embase, Scopus, ERIC and SciELO databases for articles published up to March 16, 2025, which dealt with cinema/films, medical education and psychiatry. A total of 3,391 titles/abstracts were evaluated, followed by 123 full-text articles. Quantitative (number of students) and qualitative data (level of training, thematic, teaching methodology and materials used) were extracted. For the articles that described an intervention, an evaluation of the program's evaluation level was conducted using the Kirkpatrick framework. Results: A total of 37 articles were included in the review. The majority (N=23, 62.16%) described experience with the use of multiple films and only 17 (45.94%) described an experimental study with quantification of the groups of students. Of the studies describing the experiment, only 2 (11.76%) used a control group, but without randomisation, ten (58.82%) achieved a Kirkpatrick Level 1 designation, 6 (35.29%) achieved Level 2, and only one study achieved Level 3 (5.88%). Based on the findings, it is reasonable to suggest that future strategies for using cinema to teach psychiatry, methodological rigour, and assessing their impact at higher levels of Kirkpatrick’s training evaluation model. Conclusion: This scoping review was able to compile information on experiences with the use of cinema as a strategy for teaching psychiatry. Although there have been descriptions of experiences with the use of film for medical education in psychiatry, there are still few trials with standardised interventions that demonstrate the impact on learning. While films have clear potential as teaching tools in psychiatry, further research is needed to develop more standardised and evidence-based approaches.

A prática de recordação ativa com "flashcards" ou "quizzes" pode proporcionar benefícios em retenção de conhecimento. Este estudo objetivou avaliar a usabilidade, satisfação e eficácia de um aplicativo móvel para recordação ativa em Pediatria. Trata-se de estudo em duas etapas: 1. Transversal, para avaliação da usabilidade, por meio da System Usability Scale, e aceitação de aplicativo desenvolvido para recordação ativa, entre estudantes de medicina; 2. Ensaio clínico não cego com teste cognitivo para avaliar a retenção de conhecimento. Os dados foram tabulados e analisados. O estudo foi aprovado pelo Comitê de ética. O aplicativo “PedQuiz” foi desenvolvido e disponibilizado para 36 estudantes de medicina, que observaram boa satisfação e usabilidade. O uso do aplicativo não resultou em melhora de desempenho dos alunos (p = 0,1532). O aplicativo móvel “PedQuiz” obteve boa satisfação e usabilidade na percepção dos alunos de medicina, porém não demonstrou melhora na retenção de conhecimento.