Concepções, práticas e desafios em avaliação da aprendizagem

Este trabalho apresenta e discute um conjunto de concepções, de práticas e de desafios em avaliação da aprendizagem. Neste intuito, buscou-se descrever as idéias e os objetivos que cercam a avaliação da aprendizagem, as metodologias avaliativas utilizadas e sua adequação ao processo de ensino e aprendizagem, as maneiras como são aproveitados/utilizados os resultados da avaliação e as dificuldades e limitações em implementar boas práticas avaliativas. Para isto, foi conduzida uma pesquisa exploratória bibliográfica, a partir da leitura e análise de livros, artigos, anais de congressos, teses e dissertações

Efeitos de diferentes frações inspiradas de oxigênio sobre a dinâmica respiratória em cães submetidos à infusão contínua de propofol e mantidos em ventilação espontânea

The effects of several inspired oxygen fractions (FiO2) on the respiratory dynamics in spontaneously breathing dogs submitted to continuous infusion of propofol were evaluated. Eight adult mongrel dogs were used. Each animal underwent five anesthesias, in each procedure the patient was allowed to breath a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1), G80 (FiO2 = 0.8), G60 (FiO2 =0.6), G40 (FiO2 = 0.4), and G20 (FiO2 = 0.21). To induce anesthesia, propofol was given until the animals allowed orotracheal intubation, followed by immediate continuous infusion of drug. The initial measurement (M0) was recorded thirty minutes after the infusion of propofol has begun. Additional recordings were performed at 15 minute intervals for 60 minutes (M15, M30, M45 and M60). Numeric data were submitted to Analysis of Variance followed by Tukey Test (p<0.05). We recorded significantly lower values of SpO2 and SaO2 at G20, whereas PaO2 varied according to the changes in oxygen. Regarding PaCO2, the mean of G100 was greater than G20 at M30. However, spontaneously breathing dogs anesthetized with propofol at the rate of 0.7mg/kg/min should not be provided with 100%, 80%, and 21% oxygen owing to the significant compromise of respiratory system.Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2) sobre a dinâmica respiratória em cães submetidos a infusão contínua de propofol e mantidos em ventilação espontânea. Oito cães foram submetidos a cinco anestesias diferenciando uma da outra pela FiO2 fornecida. Formaram-se cinco grupos denominados G100 (FiO2 = 1), G80 (FiO2 = 0,8), G60 (FiO2 = 0,6), G40 (FiO2 = 0,4) e G20 (FiO2 = 0,21). Os animais foram induzidos à anestesia com propofol na dose necessária para intubação, e ato contínuo iniciou-se a infusão do fármaco e o fornecimento de oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações foram efetuadas 30 minutos após o início da infusão do anestésico (M0), em seguida em intervalos de 15 minutos (M15, M30, M45 e M60). Os dados numéricos obtidos foram submetidos a Análise de Variância, seguida pelo teste Tukey (p<0,05). Os valores registrados de saturação de oxihemoglobina (SpO2) e SaO2 foram significativamente menores para G20, enquanto que a pressão parcial de oxigênio no sangue arterial (PaO2) variou conforme a fração de oxigênio fornecida. Para a pressão parcial de dióxido de carbono no sangue arterial (PaCO2) foram registradas diferenças em M30, no qual G100 apresentou médias superiores a G20. Conclui-se que o fornecimento de oxigênio a 100%, 80% e 21% devem ser evitados, pois proporciona prejuízos significativos ao sistema respiratório de cães anestesiados com infusão contínua de propofol na dose de 0,7mg/kg/min sob ventilação espontânea

Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study

Objectives: The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. Methods: Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. Results: The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00–4.06): 102 (2.13% 95% CI 1.73–2.56) with stroke and 81 (1.68% 95% CI 1.33–2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet’s disease (9.5%, 95% CI 5.79–14.37), polyarteritis nodosa (6.2%, 95% CI 3.25–10.61), and Takayasu’s arteritis (6.0%, 95% CI 4.30–8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09–3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20–3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05–9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01–2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. Conclusion: CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet’s. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence

Assistência de Enfermagem em Crianças com Leishmaniose Visceral: Revisão Integrativa.

Visceral Leishmaniasis is characterized as a disease of serious public health problem in Brazil and worldwide, popularly known as calazar, identified by long-lasting fever, asthenia, anemia, weight loss, among other clinical manifestations. When not properly treated, the individual dies. Therefore, the objective of this study is to describe the nursing attributions in the cases of children affected by visceral leishmaniasis. The integrative literature review was developed through articles found in the following databases: Lilacs; Scielo, PubMed; BVS-BIREME, and BDENF, considering the time frame of the last 10 years. After applying the eligibility criteria, ten studies were found for analysis. As a result, it was observed that the nursing process is characterized by the interrelationship and dynamism of each step. The implementation of this assistance is an indispensable procedure both for early detection of children with visceral leishmaniasis and for rehabilitation. Thus, patient care involves dialogue, humanized care, multidisciplinary service provision, focusing not only on curative assistance, but also to develop educational actions.A Leishmaniose Visceral caracteriza-se por ser uma doença de grave problema para saúde pública no Brasil e no mundo, popularmente conhecida como calazar, identificada por febre de longa duração, astenia, anemia, perda de peso, dentre outras manifestações clínicas. Quando não tratada adequadamente leva o indivíduo ao óbito. Para tanto, o objetivo deste trabalho, consiste em descrever as atribuições da enfermagem frente aos casos de crianças acometidas por leishmaniose visceral. A revisão integrativa da literatura foi desenvolvida através de artigos alcançados nas bases de dados: Lilacs; Scielo, PubMed; BVS-BIREME, e BDENF, considerando o recorte temporal dos últimos 10 anos. Diante da aplicação dos critérios de elegibilidades, encontraram-se dez estudos para análise. Como resultado, observou-se que o processo de enfermagem é caracterizado pelo inter-relacionamento e dinamismo de cada etapa. A implementação dessa assistência faz-se um procedimento imprescindível tanto para detecção precoce de crianças com leishmaniose visceral quanto para a reabilitação. Assim, o cuidado com o paciente envolve diálogo, atendimento humanizado, prestação de serviço multidisciplinar, com foco não apenas na assistência curativa, mas também, o desenvolvimento de ações educativas

Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: A multicentric observational study

Objectives: The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. Methods: Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. Results: The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00–4.06): 102 (2.13% 95% CI 1.73–2.56) with stroke and 81 (1.68% 95% CI 1.33–2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet’s disease (9.5%, 95% CI 5.79–14.37), polyarteritis nodosa (6.2%, 95% CI 3.25–10.61), and Takayasu’s arteritis (6.0%, 95% CI 4.30–8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09–3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20–3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05–9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01–2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. Conclusion: CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet’s. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Atelectasia pulmonar em cães durante anestesia geral

A pressão intrapleural normalmente é menor que a pressão intrapulmonar. Consequentemente , os pulmões tendem ao colapso e se retraem, afastando-se da parede torácica. No início do século XX, Pasteur descreveu a atelectasia pulmonar, que ocorre com frequência durante a indução anestésica, persiste no período pós-operatório e pode contribuir de maneira significativa para a morbidade e o aumento nos gastos com medicamentos. em medicina veterinária, no entanto, a atelectasia não é frequentemente diagnosticada, apesar de que isso não implica afirmar que tal afecção não ocorra, visto que existem relatos do desenvolvimento desse quadro em cães e em outras espécies. No contexto da anestesia geral, essa complicação pulmonar pode ser encontrada em animais que respiram 80 a 100% de oxigênio. A partir dessas informações, torna-se necessário que o profissional da anestesiologia veterinária obtenha conhecimentos complementares sobre o tema. Com este trabalho, objetivou-se descrever alguns dos mecanismos da atelectasia e seus pontos relevantes, de modo a familiarizar os profissionais quanto aos pormenores dessa importante, e nem sempre bem compreendida, alteração fisiológica respiratória.Pleural pressure is usually lower than pulmonary pressure. Therefore, the lungs tend to collapse and increase its distance from thoracic walls. At the beginning of 20th century, Pasteur described the pulmonary atelectasis, which develops during induction of anesthesia and persists to the postoperative period. It can contribute significantly to morbidity and to increase the medical expenses. In veterinary medicine, pulmonary atelectasis is not frequently diagnosed, which doesn't rule out the occurrence of this disease, since there are reports of atelectsasis in dogs. This pulmonary complication can be found in animals that breathe 80% to 100% oxygen in anesthetic procedures. Based on this information, the veterinary anesthesiologist is required to search for complementary knowledge regarding to pulmonary atelectasis. This study, therefore, aimed to describe some of the mechanisms involved in the development of atelectasis. It aimed also to familiarize the anesthesiologist to this not always well- understood physiological breathing change.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP