ABSTRACT
Objective: To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods: Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results: We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. (AU)
Subject(s)
Colonoscopy/education , Education, Medical, Undergraduate , Simulation Training , Colorectal Neoplasms/diagnosis , Low Cost TechnologyABSTRACT
Resumo A ponte de tirofiban é uma alternativa à suspensão da terapia antiplaquetária dupla no perioperatório de pacientes com alto risco de trombose de stent e de sangramento. Objetivamos avaliar a eficácia e a segurança deste protocolo em pacientes submetidos à cirurgia em até 12 meses após intervenção coronária percutânea com stent. Realizamos uma revisão sistemática por meio de pesquisa nas bases PubMed, Web of Science, Cochrane, EMBASE, LILACS e SciELO e nas referências de artigos relevantes ao tema. Dos 107 trabalhos encontrados, cinco foram incluídos após análise dos critérios de elegibilidade e da qualidade metodológica, totalizando 422 pacientes, sendo 227 do grupo controle. Apesar das limitações reportadas, quatro dos cinco estudos incluídos indicam que a ponte de tirofiban é eficaz em reduzir eventos cardíacos adversos e segura ao não interferir no risco de eventos hemorrágicos ou sangramentos. Todavia, são necessários ensaios clínicos randomizados para evidências robustas.
Abstract Use of a tirofiban bridge is an alternative to simply withdrawing dual antiplatelet therapy prior to operating on patients at high risk of stent thrombosis and bleeding. We aimed to evaluate the efficacy and safety of this protocol in patients undergoing surgery within 12 months of a percutaneous coronary intervention involving stenting. We performed a systematic review based on searches of the PubMed, Web of Science, Cochrane, Embase, Lilacs, and Scielo databases and of the references of relevant articles on the topic. Five of the 107 studies identified were included after application of eligibility criteria and analysis of methodological quality, totaling 422 patients, 227 in control groups. Notwithstanding the limitations reported, four of the five studies included indicate that the tirofiban bridge technique is effective for reducing adverse cardiac events and is safe in terms of not interfering with the risk of hemorrhagic events or bleeding. However, randomized clinical trials are needed to provide robust evidence.