THE EVOLUTION OF TECHNOLOGY IN EDUCATION

A tecnologia na educação tem estado fortemente presente nessas últimas décadas. E já tem sido incorporada ao discurso de profissionais da educação, podendo chegar a diversos lugares. Há uma evolução da tecnologia nas instituições educacionais. Para uma evolução educacional, é preciso investimento. Atualmente temos uma carência nos instrumentos de estudo, porém existe uma ideia para quebrar esses paradigmas, de ambos os lados, ainda existe uma falta de amadurecimento dessa ideia. São incluí­das aulas presenciais, a distância e livros-textos em formato PDF. Existem vários tipos de aprendizagem, e podem alcançar todos os ní­veis de graduações distintas. Baseamos nossa pesquisa em cinco artigos anteriores e desenvolvemos um artigo de revisão.The technology in the attention of a scenario was serious in the last decades. And it has already been, founded to the discourse of professionals of education, being able to arrive at many places. There is technology in educational institutions. For an educational recovery it takes investment. "There is a lack in the instruments of study, because there is an idea to break paradigms, on both sides, there is still a lack of maturation of this idea. Can be useful at all levels of distinct rankings based on our research on previous articles, and we have developed a review article

The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

<p>Abstract</p> <p>Background</p> <p>Minimization of hemodynamic instability during renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD).</p> <p>Methods</p> <p>This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30), SLED (n = 13) or IHD (n = 34) and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if < 90% of the prescribed time was administered. Generalized estimating equations were used to compare the hemodynamic tolerability of SLED vs CRRT while accounting for within-patient clustering of repeated sessions and key confounders.</p> <p>Results</p> <p>Hemodynamic instability occurred during 22 (56.4%) SLED and 43 (50.0%) CRRT sessions (p = 0.51). In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47), as compared to CRRT. Session interruption occurred in 16 (16.3), 30 (34.9) and 11 (28.2) of IHD, CRRT and SLED therapies, respectively.</p> <p>Conclusions</p> <p>In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.</p

Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments

Evidence is accumulating showing that septic acute kidney injury (AKI) is different from non-septic AKI. Specifically, a large body of research points to apoptotic processes underlying septic AKI. Unravelling the complex and intertwined apoptotic and immuno-inflammatory pathways at the cellular level will undoubtedly create new and exciting perspectives for the future development (e.g., caspase inhibition) or refinement (specific vasopressor use) of therapeutic strategies. Shock complicating sepsis may cause more AKI but also will render treatment of this condition in an hemodynamically unstable patient more difficult. Expert opinion, along with the aggregated results of two recent large randomized trials, favors continuous renal replacement therapy (CRRT) as preferential treatment for septic AKI (hemodynamically unstable). It is suggested that this approach might decrease the need for subsequent chronic dialysis. Large-scale introduction of citrate as an anticoagulant most likely will change CRRT management in intensive care units (ICU), because it not only significantly increases filter lifespan but also better preserves filter porosity. A possible role of citrate in reducing mortality and morbidity, mainly in surgical ICU patients, remains to be proven. Also, citrate administration in the predilution mode appears to be safe and exempt of relevant side effects, yet still requires rigorous monitoring. Current consensus exists about using a CRRT dose of 25 ml/kg/h in non-septic AKI. However, because patients should not be undertreated, this implies that doses as high as 30 to 35 ml/kg/h must be prescribed to account for eventual treatment interruptions. Awaiting results from large, ongoing trials, 35 ml/kg/h should remain the standard dose in septic AKI, particularly when shock is present. To date, exact timing of CRRT is not well defined. A widely accepted composite definition of timing is needed before an appropriate study challenging this major issue can be launched