Habilidades psicomotoras em anestesia: comparação dos relatos de turmas em dois currículos médicos

OBJECTIVE: Since 1990, the Evaluation Program for Undergraduate Medical Teachingat Universidade Federal do Rio Grande do Sul has been conducting a systematic survey to establish the opportunities granted to students to develop psychomotor skills inseveral areas. For this purpose, the students answer questionnaires at the beginningand at the end of clinical rotating internships. The aim of the present work was toassess the reports of students concerning the development of such skills during theanesthesia internship before and after a curriculum reform.MATERIALS AND METHODS: We documented 18 basic tasks performed by studentsduring the anesthesia internship. We compared the answers of 7th semester trainees(1991, old curriculum) with the answers of 10th semester trainees (1996, new curriculum).The questionnaires were applied on the first and on the last day of internship.RESULTS: Out of 18 tasks, 13 were not statistically different between the groups; in 4(blood loss estimation, installation of IVs, intravenous administration of fluids, andtransportation of unconscious patients), the old curriculum group reported significantlyhigher exposure prior to the internship; in one skill the reference to previous exposureto these tasks was higher in the new curriculum.CONCLUSIONS: The present results suggest that the perception of students concerningtheir previous experience with the psychomotor skills required for the tasks under analysistended to make them overestimate their technical skills. In 10th semester new curriculumstudents, this attitude changed significantly: students referred less to previousexperience, and seemed more motivated to develop activities that were specificallyrelated to anesthesia during the internship.OBJETIVO: O Núcleo de Avaliação do Ensino Médico da Faculdade de Medicina daUniversidade Federal do Rio Grande do Sul vem, desde 1990, aplicando questionáriosaos alunos da graduação nas fases pré e pós-realização de estágios rotatórios dociclo clínico, para estabelecer o nível de oportunidades de treinamento psicomotorem diversas áreas de ensino. Este trabalho objetiva avaliar os resultados dotreinamento em habilidades psicomotoras em estágios de Anestesia em alunos quefizeram o estágio antes e depois de uma reforma curricular.MATERIAIS E MÉTODOS: Foram documentados os levantamentos de 18 habilidadesmínimas, acessíveis ao aluno na rotina do estágio em Anestesia da disciplina deCirurgia, realizados, respectivamente, com a última geração de alunos da disciplinaMED305 (sétimo semestre, em 1991) e a nova MED03377 (décimo semestre, em1996). O levantamento de dados ocorreu mediante aplicação de questionários noprimeiro e último dia de realização do estágio, já validados para essa finalidade.RESULTADOS: Das 18 habilidades, 13 não apresentaram diferença estatisticamentesignificativa entre as turmas; em quatro habilidades foi referida uma exposição préviasignificativamente superior no currículo antigo (estimativa de perdas sangüíneas,instalação de soro, administração intravenosa de fluidos e transporte do pacienteinconsciente); em apenas uma habilidade houve referência à exposição préviasuperior no currículo 242.0.CONCLUSÕES: Os resultados obtidos sugerem que a auto-apreciação dos alunosquanto à experiência adquirida em habilidades psicomotoras, prévia à realização doestágio em Anestesia, tende a superestimar sua competência em habilidades técnicas.Adiante, no décimo semestre, este julgamento se modifica consideravelmente: osalunos referem menor nível de experiência prévia e no estágio parecem maismotivados ao desempenho de habilidades específicas ao exercício da Anestesia

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Habilidades psicomotoras em anestesia: comparação dos relatos de turmas em dois currículos médicos

OBJECTIVE: Since 1990, the Evaluation Program for Undergraduate Medical Teachingat Universidade Federal do Rio Grande do Sul has been conducting a systematic survey to establish the opportunities granted to students to develop psychomotor skills inseveral areas. For this purpose, the students answer questionnaires at the beginningand at the end of clinical rotating internships. The aim of the present work was toassess the reports of students concerning the development of such skills during theanesthesia internship before and after a curriculum reform.MATERIALS AND METHODS: We documented 18 basic tasks performed by studentsduring the anesthesia internship. We compared the answers of 7th semester trainees(1991, old curriculum) with the answers of 10th semester trainees (1996, new curriculum).The questionnaires were applied on the first and on the last day of internship.RESULTS: Out of 18 tasks, 13 were not statistically different between the groups; in 4(blood loss estimation, installation of IVs, intravenous administration of fluids, andtransportation of unconscious patients), the old curriculum group reported significantlyhigher exposure prior to the internship; in one skill the reference to previous exposureto these tasks was higher in the new curriculum.CONCLUSIONS: The present results suggest that the perception of students concerningtheir previous experience with the psychomotor skills required for the tasks under analysistended to make them overestimate their technical skills. In 10th semester new curriculumstudents, this attitude changed significantly: students referred less to previousexperience, and seemed more motivated to develop activities that were specificallyrelated to anesthesia during the internship.OBJETIVO: O Núcleo de Avaliação do Ensino Médico da Faculdade de Medicina daUniversidade Federal do Rio Grande do Sul vem, desde 1990, aplicando questionáriosaos alunos da graduação nas fases pré e pós-realização de estágios rotatórios dociclo clínico, para estabelecer o nível de oportunidades de treinamento psicomotorem diversas áreas de ensino. Este trabalho objetiva avaliar os resultados dotreinamento em habilidades psicomotoras em estágios de Anestesia em alunos quefizeram o estágio antes e depois de uma reforma curricular.MATERIAIS E MÉTODOS: Foram documentados os levantamentos de 18 habilidadesmínimas, acessíveis ao aluno na rotina do estágio em Anestesia da disciplina deCirurgia, realizados, respectivamente, com a última geração de alunos da disciplinaMED305 (sétimo semestre, em 1991) e a nova MED03377 (décimo semestre, em1996). O levantamento de dados ocorreu mediante aplicação de questionários noprimeiro e último dia de realização do estágio, já validados para essa finalidade.RESULTADOS: Das 18 habilidades, 13 não apresentaram diferença estatisticamentesignificativa entre as turmas; em quatro habilidades foi referida uma exposição préviasignificativamente superior no currículo antigo (estimativa de perdas sangüíneas,instalação de soro, administração intravenosa de fluidos e transporte do pacienteinconsciente); em apenas uma habilidade houve referência à exposição préviasuperior no currículo 242.0.CONCLUSÕES: Os resultados obtidos sugerem que a auto-apreciação dos alunosquanto à experiência adquirida em habilidades psicomotoras, prévia à realização doestágio em Anestesia, tende a superestimar sua competência em habilidades técnicas.Adiante, no décimo semestre, este julgamento se modifica consideravelmente: osalunos referem menor nível de experiência prévia e no estágio parecem maismotivados ao desempenho de habilidades específicas ao exercício da Anestesia

Swine and Poultry Pathogens: the Complete Genome Sequences of Two Strains of Mycoplasma hyopneumoniae and a Strain of Mycoplasma synoviae

This work reports the results of analyses of three complete mycoplasma genomes, a pathogenic (7448) and a nonpathogenic (J) strain of the swine pathogen Mycoplasma hyopneumoniae and a strain of the avian pathogen Mycoplasma synoviae; the genome sizes of the three strains were 920,079 bp, 897,405 bp, and 799,476 bp, respectively. These genomes were compared with other sequenced mycoplasma genomes reported in the literature to examine several aspects of mycoplasma evolution. Strain-specific regions, including integrative and conjugal elements, and genome rearrangements and alterations in adhesin sequences were observed in the M. hyopneumoniae strains, and all of these were potentially related to pathogenicity. Genomic comparisons revealed that reduction in genome size implied loss of redundant metabolic pathways, with maintenance of alternative routes in different species. Horizontal gene transfer was consistently observed between M. synoviae and Mycoplasma gallisepticum. Our analyses indicated a likely transfer event of hemagglutinin-coding DNA sequences from M. gallisepticum to M. synoviae