Avaliação na sessão tutorial do curso de medicina na Unimontes: aprendendo concepções e práticas

Este trabalho traz como objeto de pesquisa a Avaliação Formativa, referenciada a critério, que acontece durante as sessões tutoriais do Curso de Medicina da Universidade Estadual de Montes Claros, no qual desde 2002 foi implantada a metodologia Aprendizagem Baseada em Problemas (Problem Based Learning – PBL). Especificamente, objetivou apreender, na ótica de discentes e docentes, as concepções dessa avaliação, as dificuldades enfrentadas durante o processo avaliativo e a contribuição da avaliação para o processo de aprendizagem e para o crescimento pessoal dos estudantes. Os sujeitos da pesquisa foram 11 tutores e 45 discentes do sétimo período do curso. Os dados foram coletados por meio de questionário com assertivas relacionadas à temática pesquisada e análise do grau de concordância e/ou discordância que foram quantificados, tabulados e dispostos em gráficos. Para o aprofundamento dos dados, utilizamos a entrevista semiestruturada, cujos dados foram submetidos à Análise Temática. Os entrevistados percebem a proposta formativa da avaliação na sessão tutorial, definindo-a como processual, reflexiva, dialógica, diagnóstica; enfatizam a possibilidade de feedback como fator motivador e determinante para solucionar as deficiências detectadas e reforçar as potencialidades percebidas. Os participantes têm vivenciado dificuldades durante o processo avaliativo relacionadas ao desempenho dos docentes (falta de preparo e de compromisso), ao desempenho dos estudantes (falta de sinceridade, maturidade e preparo) e outras decorrentes de fatores institucionais, como a inadequação dos critérios utilizados nos instrumentos avaliativos. Os resultados apontam para a necessidade de programas de desenvolvimento docente e também discente em avaliação, assim como maior compromisso das instituições que utilizam a metodologia PBL na busca contínua e reflexiva, em coerência com os pressupostos pedagógicos estabelecidos pelo currículo. Apesar das dificuldades, emerge a percepção dos entrevistados em relação à contribuição do momento avaliativo, para a aprendizagem, permitindo a construção do conhecimento, identificação de lacunas, análise crítica das fontes bibliográficas, compromisso com o aprendizado coletivo; e promovendo uma retroalimentação das atividades, fator contributivo para melhorias no curso. Acresça-se, ainda, o avanço quando apresentam um olhar para além do biológico identificando a avaliação como possibilidade de desenvolvimento de habilidades de relacionamento interpessoal, de comunicação, capacitação para a educação permanente, valorização da ética e dos aspectos psicossociais dos pacientes, enfatizados como essenciais para a prática médica.This research is about the Formative Evaluation that happens during the tutorials sessions of the Medicine course at Universidade Estadual de Montes Claros, where since 2002 the Problem-based Learning (PBL) methodology was implanted. It specifically had the objective of understanding the students and professor’s perspective, the conceptions of this evaluation, to raise the difficulties that we have to deal with during the evaluation process and the contribution of the evaluation to the learning process and to the students` personal development . The subject of this research were 11 tutors and 45 4th year medical students .The data were collected through a questionnaire with assertions related to the subject that had been researched and analysis of the level of agreement and disagreement that were quantified in tabular form and graphic data. In order to make a profound study of the data we used a semi-structured interview whose data were submitted to Thematic Analysis. The interviewees perceive the formative proposal of the evaluation in the tutorial session, defining it as procedural, reflexive, dialogic, diagnostic. They emphasize the possibility of feedback as a motivating and determinant fact to solve the detected deficiencies and reinforce the perceived potential. The participants had some difficulties during the evaluation process related to the professors` performance ( lack of knowledge about how to evaluate and commitment), students` performance ( lack of sincerity , maturity and knowledge about how to evaluate,) and others that are consequence of institutional factors like inadequate criteria on the evaluating options. The results show the necessity of programs to develop professors and students that have been evaluated, such as commitment of the institutes that work with the PBL methodology trying to get a reflexive coherence with the pedagogical presupposition established in the curriculum. Although difficulties, the interviewees` perception appear related to the contribution of the evaluative moment to the learning process .It permits to build knowledge, identify gaps, critical analysis of the bibliographic reference, commitment with the collective learning and determining a feedback of the activities, a contributive factor to make the course better. Besides, when they present an interest that is not just biological, identifying in the evaluation the possibility of abilities development, interpersonal relationship, communication, permanent education, appreciation of ethic and psychosocial aspects of the patients, emphasized as essential in the medical practice.TEDEBV UNIFESP: Teses e dissertaçõe

Avaliação formativa em sessão tutorial: concepções e dificuldades

A proposta deste trabalho é apreender concepções de estudantes e tutores sobre a avaliação formativa nas sessões tutoriais de um currículo PBL, identificando as dificuldades enfrentadas no desenvolvimento dessa prática. Um questionário Likert foi aplicado a 11 tutores e 45 discentes do sétimo período do curso de Medicina da Universidade Estadual de Montes Claros e uma entrevista de aprofundamento foi realizada com a totalidade dos tutores e 20 estudantes. Os entrevistados percebem a proposta formativa da avaliação na sessão tutorial, definindo-a como processual, reflexiva, dialógica, diagnóstica, e enfatizam a possibilidade de feedback como fator motivador e determinante para solucionar as deficiências detectadas e reforçar as potencialidades percebidas. São identificadas dificuldades relacionadas ao desempenho dos docentes, como falta de preparo, ao desempenho dos estudantes (falta de sinceridade, maturidade) e outras decorrentes da inadequação dos critérios utilizados nos instrumentos avaliativos. Os resultados apontam a necessidade de programas de desenvolvimento docente e discente em avaliação, assim como maior compromisso das instituições que utilizam a metodologia Aprendizagem Baseada em Problemas na busca contínua e reflexiva da coerência com os pressupostos pedagógicos estabelecidos pelo currículo

Teses sobre hepatites na Faculdade de Medicina da Universidade Federal do Rio de Janeiro, 1837-2000 Theses on hepatitis at the Faculdade de Medicina of the Universidade Federal do Rio de Janeiro, 1837-2000

Apresenta inventário das teses sobre hepatites da Faculdade de Medicina da Universidade Federal do Rio de Janeiro entre 1837 e 2000. A análise indica potencialidades e limites para discussão do quadro evolutivo do conhecimento científico no Brasil sobre esses agravos. As teses também são discutidas à luz de seus referenciais científicos e das mudanças tecnológicas e sociais que as influenciaram. Identificam-se e categorizam-se os marcos do ensino médico e do conhecimento sobre as hepatites, considerando que as teses revelam, no mínimo, o estado da arte de seu objeto. O estudo permitiu explorar as bases em que os saberes científicos sobre as hepatites foram construídos e indicar possibilidades de pesquisas na reconstrução do conhecimento científico de outros agravos.<br>An inventory of the theses on hepatitis of the Faculdade de Medicina of the Universidade Federal do Rio de Janeiro between 1837 and 2000 is presented. The analysis indicates the potential and limits for discussion of the evolutionary framework of scientific knowledge on these health problems in Brazil. The theories are also discussed in light of their scientific reference points and the technological and social changes that influenced them. The landmarks in medical education and knowledge about hepatitis are identified and categorized, considering that the theses reveal at the very least the state of the art on the subject. The study makes it possible to explore the foundations upon which the scientific knowledge on hepatitis were built and indicate possibilities for research in the reconstruction of scientific knowledge of other health problems

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

International audienceBackground: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use