Processo de ensino e aprendizagem no período de suspensão das aulas presenciais em virtude da pandemia de COVID-19: estudo com professores / Teaching and learning process in the suspension period of classes in virtue of the COVID-19 pandemy: study with teachers / Proceso de enseñanza y aprendizaje durante el período de suspensión de clases presencial por la pandemia del COVID-19: estudio con docentes

Introdução: Sabe-se que durante o período da pandemia do COVID-19, escolas e professores precisaram adaptar-se com alternativas para dar continuidade às aulas. Objetivo: Investigar estratégias e recursos pedagógicos de aprendizagem adotados por professores da rede pública e/ou privada de ensino, do interior de um estado brasileiro, durante o período de suspensão das aulas presenciais, em virtude da Pandemia de Covid-19 e seus efeitos para estudantes com e sem dificuldades de aprendizagem. Método: Aplicação de questionário on-line utilizando a ferramenta Google Forms para 37 professores atuantes do 1° ao 5° ano da rede pública e/ou privada no interior do estado, que tenham trabalhado remotamente durante a Pandemia no período de suspensão das aulas presenciais. Esse material continha questões de múltipla escolha e dissertativas e averiguava a forma de trabalho durante este período, as estratégias e os recursos adotados. Resultados: Os resultados mostraram que as estratégias mais utilizadas pelos professores foram uso de materiais impressos. Os professores relataram as dificuldades e os desafios em adotar o ensino remoto, referentes à desigualdade social dos alunos, a dificuldade de adaptação dos professores a esta forma de ensino e ao empenho restrito das famílias no processo de aprendizagem. Conclusão: foi possível verificar como ocorreu o processo de adaptação ao ensino remoto pelos professores. Verifica-se a necessidade de explorar o trabalho conjunto com a Fonoaudiologia, visando minimizar as dificuldades apresentadas pelos estudantes, o que auxiliaria no processo de ensino e aprendizagem dos alunos que, posteriormente, poderiam vir a ser futuros pacientes do setor de Fonoaudiologia. (AU)

Introduction: it is known that during the period of the COVID-19 pandemic, schools and teachers needed to adapt with alternatives to continue classes. Purpose: Investigate pedagogical learning strategies and resources adopted by teachers from public and/or private schools in the interior of a Brazilian state during the period of suspension of face-to-face classes, due to the Covid-19 Pandemic and its effects on students with and without learning difficulties. Method: This research included the application of an online questionnaire through Google Forms to 37 active teachers from the 1st to the 5th year of the public and/or private network at Brasilian state who have worked remotely during the Pandemic during the suspension period of in-person classes. This material contained multiple choice questions and essays, referring to the way of working during this period, strategies and resources adopted. Results: The results showed that the most used strategies by teachers were the use of printed materials. Teachers reported the difficulties and challenges in adopting remote teaching, referring to the social inequality of students, the limited commitment of families in the learning process and the difficulty of teachers to adapt to this form of teaching. Conclusion: Among 37 teachers who joined the study, it was possible to verify how the process of adaptation to remote teaching took place. There is a need to explore the joint work with Speech Therapy, aiming to minimize the difficulties presented by students. Such clarifications would help in the teaching and learning process of students who could later become future patients in the Speech Therapy sector. (AU)

Introducción: se sabe que durante el período de la pandemia del COVID-19, las escuelas y los docentes requirieron adaptarse con alternativas para continuar las clases. Objetivos: Investigar estrategias y recursos pedagógicos de aprendizaje adoptados por profesores de escuelas públicas y/o privadas del interior de un estado brasileño durante el período de suspensión de clases presenciales, debido a la Pandemia Covid-19 y sus efectos en estudiantes con y sin dificultades de aprendizaje. Método: Esta investigación implicó la aplicación de un cuestionario en línea a través de Formularios de Google a 37 docentes que laboran del 1° al 5° año de la red pública y/o privada del interior del estado, que habían trabajado de manera remota durante la Pandemia en el período de suspensión de clases presenciales. Este material contenía preguntas de selección múltiple y desarrollo, referentes a la forma de trabajar durante este período, las estrategias y los recursos adoptados. Resultados: Los resultados mostraron que las estrategias más utilizadas por los docentes fue el uso de materiales impresos. Los docentes relataron las dificultades y desafíos en la adopción de la enseñanza a distancia, refiriéndose a la desigualdad social de los estudiantes, el compromiso restringido de las familias en el proceso de aprendizaje y la dificultad de adaptación de los docentes a esta forma de enseñanza. Conclusión: Entre 37 docentes que se sumaron al estudio, fue posible verificar cómo ocurrió el proceso de adaptación a la enseñanza a distancia. Existe la necesidad de explorar el trabajo conjunto con la Logopedia, con el objetivo de minimizar las dificultades presentadas por los estudiantes. Tales aclaraciones ayudarían en el proceso de enseñanza y aprendizaje de los estudiantes que luego podrían convertirse en futuros pacientes del sector de Logopedia. (AU)

Realidad virtual y biomarcadores digitales: una herramienta clínica para el diagnóstico del autismo / Virtual reality and digital biomarkers: a clinical tool for early autism diagnosis

Resumen Introducción : El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo, y sus procedimien tos tradicionales de evaluación encuentran ciertas li mitaciones. El actual campo de investigación sobre TEA está explorando y respaldando métodos innovadores para evaluar el trastorno tempranamente, basándose en la detección automática de biomarcadores. Sin embargo, muchos de estos procedimientos carecen de validez ecológica en sus mediciones. En este contexto, la reali dad virtual (RV) presenta un prometedor potencial para registrar objetivamente bioseñales mientras los usuarios experimentan situaciones ecológicas. Métodos : Este estudio describe un novedoso y lúdi co procedimiento de RV para la evaluación temprana del TEA, basado en la grabación multimodal de bio señales. Durante una experiencia de RV con 12 esce nas virtuales, se midieron la mirada, las habilidades motoras, la actividad electrodermal y el rendimiento conductual en 39 niños con TEA y 42 compañeros de control. Se desarrollaron modelos de aprendizaje automático para identificar biomarcadores digitales y clasificar el autismo. Resultados : Las bioseñales reportaron un rendimien to variado en la detección del TEA, mientras que el modelo resultante de la combinación de los modelos de las bioseñales demostró la capacidad de identificar el TEA con una precisión del 83% (DE = 3%) y un AUC de 0.91 (DE = 0.04). Discusión : Esta herramienta de detección pue de respaldar el diagnóstico del TEA al reforzar los resultados de los procedimientos tradicionales de evaluación.

Abstract Introduction : Autism Spectrum Disorder (ASD) is a neurodevelopmental condition which traditional as sessment procedures encounter certain limitations. The current ASD research field is exploring and endorsing innovative methods to assess the disorder early on, based on the automatic detection of biomarkers. How ever, many of these procedures lack ecological validity in their measurements. In this context, virtual reality (VR) shows promise for objectively recording biosignals while users experience ecological situations. Methods : This study outlines a novel and playful VR procedure for the early assessment of ASD, relying on multimodal biosignal recording. During a VR experience featuring 12 virtual scenes, eye gaze, motor skills, elec trodermal activity and behavioural performance were measured in 39 children with ASD and 42 control peers. Machine learning models were developed to identify digital biomarkers and classify autism. Results : Biosignals reported varied performance in detecting ASD, while the combined model resulting from the combination of specific-biosignal models demon strated the ability to identify ASD with an accuracy of 83% (SD = 3%) and an AUC of 0.91 (SD = 0.04). Discussion : This screening tool may support ASD diagnosis by reinforcing the outcomes of traditional assessment procedures.

Fundamentos teóricos de una investigación sobre competencia profesional comunicativa en el docente de la educación médica superior

La competencia profesional comunicativa resulta una necesidad para el logro del desarrollo discursivo en las ciencias médicas, pero sucede que en numerosos casos se adolece de preparación didáctica por desconocimiento sobre competencia comunicativa. Es propósito de este texto fundamentar los presupuestos teóricos que sustentan los estudios sobre el desarrollo de la competencia comunicativa para el desempeño profesional del docente de la educación médica superior. El texto constituye una salida del proyecto de investigación no asociado al programa Perfeccionamiento de competencias profesionales en el contexto de la salud que lidera el Centro de Desarrollo de las Ciencias Sociales y Humanísticas en Salud. Se efectúo la búsqueda en bibliografía impresa y digital certificada, se consultaron bases de datos como SciELOCuba, SciELO Regional, los sitios web Organización Panamericana de la Salud, Organización Mundial de la Salud. El estudio de documentos propició la determinación de los presupuestos teóricos que sustentan el estudio que se desarrolló desde enero de 2021 a diciembre de 2023.

The talkative professional competition is vital in the educational one that imparts the subject History of Cuba in the Medical Sciences, but, it happens that in numerous cases didactic preparation suffers due to lack of knobbledge and communicative competence. It is purpose of this text to substantiate the theoretical assumptions that support studies on the development communicative for the professional performance of Cuban history teachers. It not belongs to the project associated to program: Improvement of professional competitions in the context of the health that leads the Center of Development of the Social and Humanistic Sciences in Health 2021-2023. You makes the search scientifically in certified printed and digital bibliography, databases like SciELOCuba are consulted, Regional SciELO, the places web Pan-American Organization of the Health, World Organization of the Health. The study of documents propitiated the elements to apply for the professors of the subject to reach the professional competition in the formative process.

Uso del Diseño Universal para el Aprendizaje para Mejorar la Práctica Docente y la Motivación de los Estudiantes en Anatomía: Una Propuesta de Intervención

En la asignatura de anatomía aún existen estudiantes que no se encuentran motivados con su propio proceso de aprendizaje. El rol del docente es un factor extrínseco clave que contribuye a dicha vinculación afectiva. El Diseño Universal para el Aprendizaje (DUA) es un modelo educativo que propone una serie de pautas de aplicación docente para poder activar en los alumnos sus redes neuronales afectivas, asociadas con la formación de estudiantes decididos y motivados. El objetivo de este estudio es crear una propuesta de intervención, basada en el uso selectivo de las pautas de compromiso afectivo del DUA, para mejorar la práctica docente y la motivación de los estudiantes en anatomía. Es una investigación acción que utiliza el modelo de Whitehead, implicando el cruce conceptual y metodológico entre las pautas de compromiso afectivo del DUA y las fases y factores que determinan la motivación. Corresponde a la programación de seis sesiones de laboratorio de anatomía, los instrumentos para la recopilación de la información y las técnicas de análisis de la misma. La propuesta de intervención presenta un valor teórico ya que fue diseñada a partir de un análisis exhaustivo del DUA y de las publicaciones existentes sobre la motivación, y un valor práctico que se sustenta en su aplicabilidad directa y recursiva en los laboratorios de anatomía y en la incorporación del DUA en el currículum de una asignatura de educación superior. La motivación es el motor de la educación, ya que impulsa y mantiene el quehacer académico tanto a nivel estudiantil como docente. El DUA permite que los docentes aborden la desmotivación de los estudiantes de una forma accesible, precisa y confiable, lo que llevó a considerarlo como uno de los pilares de la propuesta de intervención.

SUMMARY: In anatomy courses there are still students who are not motivated by their own learning process. The teacher´s role is a key extrinsic factor that contributes to this bonding process. Universal Design for Learning (UDL) is an educational model that proposes a series of teaching application guidelines to activate students' affective neural networks, associated with the formation of motivated students. The objective of this study is to create an intervention proposal, based on the selective use of the UDL affective commitment guidelines, to improve teaching practice and student motivation in anatomy. It is an action research that uses Whitehead's model, involving the conceptual and methodological intersection between the UDL's affective commitment guidelines and the phases and factors that determine motivation. It corresponds to the programming of six anatomy laboratory sessions, the instruments for collecting information and the techniques for analyzing it. The intervention proposal has a theoretical value since it was designed based on an exhaustive analysis of the UDL and existing publications on motivation, and a practical value that is based on its direct and recursive applicability in anatomy laboratories and in the incorporation of the UDL in the curriculum of a higher education subject. Motivation is the driving force of education, since it drives and maintains academic work at both the student and teacher level. The UDL allows teachers to address student lack of motivation in an accessible, precise and reliable way, considering this one of the pillars of the intervention proposal.

Examen Práctico Objetivo Estructurado como metodología de evaluación en la asignatura de Anatomía Humana: Experiencia de una Implementación Piloto

Aprendizajes en anatomía humana tradicionalmente han sido evaluados a través del reconocimiento de estructuras anatómicas. A pesar de su popularidad, pueden tener un componente subjetivo y memorístico. El Examen Práctico Objetivo Estructurado (EPOE) se ha presentado como una manera más global de evaluación. El objetivo de este estudio fue evidenciar el efecto en el rendimiento académico tras la implementación del EPOE en pasos prácticos. En el estudio 2312 estudiantes fueron divididos: Metodología Tradicional (n=1155) y Metodología EPOE (n=1157). A su vez, los estudiantes fueron identificados según carrera: Enfermería (n=1182); Fonoaudiología (n=185); Kinesiología (n=514) y Terapia Ocupacional (n=431). Se mantuvieron las condiciones de la asignatura en ambos grupos con tres evaluaciones prácticas. Se analizaron las calificaciones obtenidas. Evaluaciones 1 y 2 no presentaron diferencias entre grupos. Evaluación 3, que evaluó sistema nervioso, mostró disminución significativa de 0,5 puntos en el grupo EPOE. El factor tipo de metodología resultó ser significativo en evaluación 3 (p < 0,001; h2p = 0,029) y promedio de las 3 evaluaciones (p < 0,029; h2p = 0,002). El factor carrera resultó ser significativo para las tres evaluaciones. La interacción de ambos factores no mostró significancia estadística. El análisis post hoc mostró diferencias significativas entre estudiantes de Enfermería con las demás carreras, ya que obtuvieron mejores calificaciones en todas las evaluaciones (p < 0,05). Metodología EPOE no produjo drásticos cambios en el rendimiento académico de los estudiantes y tiene un amplio potencial de desarrollo por su naturaleza de evaluación integral no invasiva ni traumática. Se debe considerar la naturaleza de los contenidos en el diseño de la metodología de enseñanza-aprendizaje y en la metodología de evaluación, alineando a nivel microcurricular estos aspectos fundamentales de la formación de nuevos profesionales de la salud.

SUMMARY: Learning in human anatomy has traditionally been assessed by recognizing anatomical structures. Despite their popularity, they can have a subjective component. The Objective Structured Practical Examination (EPOE) has been presented as a more global way of assessment. The aim of this study was to demonstrate the effect on academic performance after the implementation of the EPOE in practical activities. In this study 2312 students were divided into Traditional Methodology (n=1155) and EPOE Methodology (n=1157). In turn, students were identified according to career: Nursing (n=1182), Speech Therapy (n=185), Physical Therapy (n=514), and Occupational Therapy (n=431). Subject conditions were maintained in both groups with three practical evaluations. The grades obtained were analyzed. Assessments 1 and 2 showed no differences between groups. Evaluation 3, which evaluated the nervous system, showed a significant decrease of 0.5 points in the EPOE group. The type of methodology factor was significant in evaluation 3 (p < 0.001; ?2p = 0.029) and the average of 3 evaluations (p < 0.029; ?2p = 0.002). The career factor was significant for all three evaluations. The interaction of both factors did not show statistical significance. The post hoc analysis showed significant differences between nursing students and the other careers since they obtained better scores in all evaluations (p < 0.05). EPOE methodology did not produce drastic changes in students' academic performance and had a broad potential for development due to its non-invasive and non-traumatic comprehensive assessment nature. The nature of the contents should be considered in the design of the teaching-learning methodology and the evaluation methodology, aligning at the micro-curricular level with these fundamental aspects of training new health professionals.

Wiki educativa para la Clínica Virtual de Salud de Santiago de Cuba

El programa de las tecnologías de la información y las comunicaciones se ha implementado en todas las instituciones pertenecientes al sector de la salud en Cuba, pues favorece la formación a través de los entornos de enseñanza y aprendizaje en función del desarrollo y las perspectivas académicas, mediante plataformas tecnológicas para facilitar el intercambio de información. En el presente artículo se destaca la necesidad de incrementar el uso de la wiki como herramienta educativa, que favorece el aprendizaje colaborativo como un proceso de creación de conocimiento a través de la web 2.0, donde no solo se publican contenidos sino que contribuye a desarrollar habilidades de cooperación en los procesos formativos de la salud pública.

The program of information and communications technologies has been implemented in all the institutions belonging to the health sector in Cuba, because it favors the training through the teaching and learning environments in function of development and academic perspectives, by means of technological platforms to facilitate the exchange of information. In this work the necessity to increase the wiki use as educational tool in enhanced, that favors the collaborative learning as a process of knowledge creation through the web 2.0, where contents are not only published but also contributes to develop cooperation abilities in the training processes of public health.

ChatGPT's learning and reasoning capacity in anesthesiology

Introduction: Over the past few months, ChatGPT has raised a lot of interest given its ability to perform complex tasks through natural language and conversation. However, its use in clinical decision-making is limited and its application in the field of anesthesiology is unknown. Objective: To assess ChatGPT's basic and clinical reasoning and its learning ability in a performance test on general and specific anesthesia topics. Methods: A three-phase assessment was conducted. Basic knowledge of anesthesia was assessed in the first phase, followed by a review of difficult airway management and, finally, measurement of decision-making ability in ten clinical cases. The second and the third phases were conducted before and after feeding ChatGPT with the 2022 guidelines of the American Society of Anesthesiologists on difficult airway management. Results: On average, ChatGPT succeded 65% of the time in the first phase and 48% of the time in the second phase. Agreement in clinical cases was 20%, with 90% relevance and 10% error rate. After learning, ChatGPT improved in the second phase, and was correct 59% of the time, with agreement in clinical cases also increasing to 40%. Conclusions: ChatGPT showed acceptable accuracy in the basic knowledge test, high relevance in the management of specific difficult airway clinical cases, and the ability to improve after learning.

Introducción: En los últimos meses, ChatGPT ha suscitado un gran interés debido a su capacidad para realizar tareas complejas a través del lenguaje natural y la conversación. Sin embargo, su uso en la toma de decisiones clínicas es limitado y su aplicación en el campo de anestesiología es desconocido. Objetivo: Evaluar el razonamiento básico, clínico y la capacidad de aprendizaje de ChatGPT en una prueba de rendimiento sobre temas generales y específicos de anestesiología. Métodos: Se llevó a cabo una evaluación dividida en tres fases. Se valoraron conocimientos básicos de anestesiología en la primera fase, seguida de una revisión del manejo de vía aérea difícil y, finalmente, se midió la toma de decisiones en diez casos clínicos. La segunda y tercera fases se realizaron antes y después de alimentar a ChatGPT con las guías de la Sociedad Americana de Anestesiólogos del manejo de la vía aérea difícil del 2022. Resultados: ChatGPT obtuvo una tasa de acierto promedio del 65 % en la primera fase y del 48 % en la segunda fase. En los casos clínicos, obtuvo una concordancia del 20 %, una relevancia del 90 % y una tasa de error del 10 %. Posterior al aprendizaje, ChatGPT mejoró su tasa de acierto al 59 % en la segunda fase y aumentó la concordancia al 40 % en los casos clínicos. Conclusiones: ChatGPT demostró una precisión aceptable en la prueba de conocimientos básicos, una alta relevancia en el manejo de los casos clínicos específicos de vía aérea difícil y la capacidad de mejoría secundaria a un aprendizaje.

Artificial intelligence, applications and challenges in simulation-based education

The rapid advancement of Artificial Intelligence (AI) has taken the world by "surprise" due to the lack of regulation over this technological innovation which, while promising application opportunities in different fields of knowledge, including education, simultaneously generates concern, rejection and even fear. In the field of Health Sciences Education, clinical simulation has transformed educational practice; however, its formal insertion is still heterogeneous, and we are now facing a new technological revolution where AI has the potential to transform the way we conceive its application.

El rápido avance de la inteligencia artificial (IA) ha tomado al mundo por "sorpresa" debido a la falta de regulación sobre esta innovación tecnológica, que si bien promete oportunidades de aplicación en diferentes campos del conocimiento, incluido el educativo, también genera preocupación e incluso miedo y rechazo. En el campo de la Educación en Ciencias de la Salud la Simulación Clínica ha transformado la práctica educativa; sin embargo, aún es heterogénea su inserción formal, y ahora nos enfrentamos a una nueva revolución tecnológica, en la que las IA tienen el potencial de transformar la manera en que concebimos su aplicación.

Impacto psicológico y estrategias innovadoras incluyentes de la gestión por procesos de habilidades para aprender a cuidar la salud mental

Fundamento: Las estrategias innovadoras incluyen a la gestión por procesos para evitar que trabajadores resulten propensos a tener dificultades en su desempeño a causa del impacto psicológico. Resulta necesario que la administración adopte procesos de aprendizaje para el desarrollo de habilidades sociales que permitan el cuidado de la salud mental de los trabajadores y contrarrestar el efecto negativo del impacto psicológico. Objetivo: Determinar la influencia en el impacto psicológico de las estrategias innovadoras con habilidades sociales para cuidar la salud mental desarrolladas mediante el aprendizaje por indagación en la gestión por procesos. Métodos: Se realizó un estudio transversal, no experimental, con alcance descriptivo y correlacional y un enfoque cuantitativo. La muestra fue de 64 trabajadores de la subgerencia de educación, salud y deportes de una municipalidad. Para la recopilación de la información de las variables definidas se utilizaron cuestionarios empleados en investigaciones efectuadas en Perú. La hipótesis nula fue: no influye en el impacto psicológico las estrategias innovadoras que incluyen la gestión por procesos de habilidades sociales adquiridas mediante aprendizaje por indagación para cuidar la salud mental de los trabajadores de una municipalidad del Perú. Resultados: Existió una relación entre el impacto psicológico y las estrategias innovadoras que incluyen la gestión por procesos, determinada por las habilidades sociales adquiridas mediante el aprendizaje por indagación para cuidar la salud mental; con una relación de 0,86 y un nivel de significación de 0,000. Conclusiones: Existe alta influencia en el impacto psicológico de las estrategias innovadoras que incluyen a la gestión por procesos de las habilidades sociales desarrolladas mediante el aprendizaje por indagación para cuidar la salud mental de los trabajadores.

Foundation: Innovative strategies include process management to prevent workers from being prone to difficulties in their performance due to the psychological impact. It is necessary for the administration to adopt learning processes for the development of social skills that allow the care of the mental health of workers and counteract the negative effect of the psychological impact. Objective: To determine the influence on the psychological impact of innovative strategies with social skills to care for mental health developed through inquiry learning in process management. Methods: The research had a cross-sectional, non-experimental design, with a descriptive and correlational scope and a quantitative approach. The sample was 64 workers from the deputy management of education, health and sports of a municipality. To collect information on the defined variables, questionnaires used in research carried out in Peru were used. The null hypothesis was: in the psychological impact does not influence the innovative strategies on process management of social skills acquired through inquiry learning to care for the mental health of workers in a municipality in Peru. Results: There was a relationship between the psychological impact and the innovative strategies on process management determined by the social skills acquired through inquiry learning to care for mental health; with a ratio of 0.86 and a significance level of 0.000. Conclusions: There is a high influence on the psychological impact of innovative strategies that include process management of social skills developed through inquiry learning to care for the mental health of workers.

Optimización de la interpretación de ecocardiogramas con la utilización de Machine Learning en el estudio WASE / Optimizing Echocardiograms Interpretation with the Application of Machine Learning in the WASE Study

RESUMEN Introducción: El número creciente de estudios ecocardiográficos y la necesidad de cumplir rigurosamente con las recomendaciones de guías internacionales de cuantificación, ha llevado a que los cardiólogos deban realizar tareas sumamente extensas y repetitivas, como parte de la interpretación y análisis de cantidades de información cada vez más abrumadoras. Novedosas técnicas de machine learning (ML), diseñadas para reconocer imágenes y realizar mediciones en las vistas adecuadas, están siendo cada vez más utilizadas para responder a esta necesidad evidente de automatización de procesos. Objetivos: Nuestro objetivo fue evaluar un modelo alternativo de interpretación y análisis de estudios ecocardiográficos, basado fundamentalmente en la utilización de software de ML, capaz de identificar y clasificar vistas y realizar mediciones estandarizadas de forma automática. Material y métodos: Se utilizaron imágenes obtenidas en 2000 sujetos normales, libres de enfermedad, de los cuales 1800 fueron utilizados para desarrollar los algoritmos de ML y 200 para su validación posterior. Primero, una red neuronal convolucional fue desarrollada para reconocer 18 vistas ecocardiográficas estándar y clasificarlas de acuerdo con 8 grupos (stacks) temáticos. Los resultados de la identificación automática fueron comparados con la clasificación realizada por expertos. Luego, algoritmos de ML fueron desarrollados para medir automáticamente 16 parámetros de eco Doppler de evaluación clínica habitual, los cuales fueron comparados con las mediciones realizadas por un lector experto. Finalmente, comparamos el tiempo necesario para completar el análisis de un estudio ecocardiográfico con la utilización de métodos manuales convencionales, con el tiempo necesario con el empleo del modelo que incorpora ML en la clasificación de imágenes y mediciones ecocardiográficas iniciales. La variabilidad inter e intraobservador también fue analizada. Resultados: La clasificación automática de vistas fue posible en menos de 1 segundo por estudio, con una precisión de 90 % en imágenes 2D y de 94 % en imágenes Doppler. La agrupación de imágenes en stacks tuvo una precisión de 91 %, y fue posible completar dichos grupos con las imágenes necesarias en 99% de los casos. La concordancia con expertos fue excelente, con diferencias similares a las observadas entre dos lectores humanos. La incorporación de ML en la clasificación y medición de imágenes ecocardiográficas redujo un 41 % el tiempo de análisis y demostró menor variabilidad que la metodología de interpretación convencional. Conclusión: La incorporación de técnicas de ML puede mejorar significativamente la reproducibilidad y eficiencia de las interpretaciones y mediciones ecocardiográficas. La implementación de este tipo de tecnologías en la práctica clínica podría resultar en reducción de costos y aumento en la satisfacción del personal médico.

ABSTRACT Background: The growing number of echocardiographic tests and the need for strict adherence to international quantification guidelines have forced cardiologists to perform highly extended and repetitive tasks when interpreting and analyzing increasingly overwhelming amounts of data. Novel machine learning (ML) techniques, designed to identify images and perform measurements at relevant visits, are becoming more common to meet this obvious need for process automation. Objectives: Our objective was to evaluate an alternative model for the interpretation and analysis of echocardiographic tests mostly based on the use of ML software in order to identify and classify views and perform standardized measurements automatically. Methods: Images came from 2000 healthy subjects, 1800 of whom were used to develop ML algorithms and 200 for subsequent validation. First, a convolutional neural network was developed in order to identify 18 standard echocardiographic views and classify them based on 8 thematic groups (stacks). The results of automatic identification were compared to classification by experts. Later, ML algorithms were developed to automatically measure 16 Doppler scan parameters for regular clinical evaluation, which were compared to measurements by an expert reader. Finally, we compared the time required to complete the analysis of an echocardiographic test using conventional manual methods with the time needed when using the ML model to classify images and perform initial echocardiographic measurements. Inter- and intra-observer variability was also analyzed. Results: Automatic view classification was possible in less than 1 second per test, with a 90% accuracy for 2D images and a 94% accuracy for Doppler scan images. Stacking images had a 91% accuracy, and it was possible to complete the groups with any necessary images in 99% of cases. Expert agreement was outstanding, with discrepancies similar to those found between two human readers. Applying ML to echocardiographic imaging classification and measurement reduced time of analysis by 41% and showed lower variability than conventional reading methods. Conclusion: Application of ML techniques may significantly improve reproducibility and efficiency of echocardiographic interpretations and measurements. Using this type of technologies in clinical practice may lead to reduced costs and increased medical staff satisfaction.

Inteligencia artificial. Aplicación en las imágenes cardiovasculares y la prevención cardiovascular / Artificial Intelligence in Cardiovascular Imaging and Cardiovascular Prevention

RESUMEN La inteligencia artificial (IA) está basada en programas computacionales que pueden imitar el pensamiento humano y automatizar algunos procesos. En el ámbito médico se está estudiando hace más de 50 años, pero en los últimos años el crecimiento ha sido exponencial. El campo de las imágenes cardiovasculares es particularmente atractivo para aplicarla, dado que, guiadas por IA, personas no expertas pueden adquirir imágenes completas, automatizar procesos y mediciones, orientar diagnósticos, detectar hallazgos no visibles al ojo humano, realizar diagnósticos oportunistas de afecciones no buscadas en el estudio índice pero evaluables a través de las imágenes disponibles, o identificar patrones de asociación dentro de una gran cantidad de datos como fuente de generación de hipótesis. En el campo de la prevención cardiovascular, la IA se ha aplicado en diferentes escenarios con fines diagnósticos, pronósticos y terapéuticos en el manejo de algunos factores de riesgo cardiovascular, como las dislipidemias o la hipertensión arterial. Si bien existen limitaciones con el uso de la IA tales como el costo, la accesibilidad y la compatibilidad de los programas, la validez externa de los resultados en determinadas poblaciones, o algunos aspectos éticos-legales (privacidad de los datos), esta tecnología está en crecimiento vertiginoso y posiblemente revolucione la práctica médica actual.

ABSTRACT Artificial intelligence (AI) is based on computer programs that imitate human thinking and automate certain processes. Artificial intelligence has been studied in the medical field for over 50 years, but in recent years, its growth has been exponential. The field of cardiovascular imaging is particularly attractive since AI can guide non-experts in image acquisition, automate processes and measurements, guide diagnoses, detect findings not visible to the human eye, make opportunistic diagnoses of unexpected conditions in the index test, or identify patterns of association within a large amount of data as a source of hypothesis generation. In the field of cardiovascular prevention, AI has been used for diagnostic, prognostic, and therapeutic purposes in managing cardiovascular risk factors such as dyslipidemia and hypertension. While there are limitations to the use of AI, such as cost, accessibility, compatibility of programs, external validity of results in certain populations, and ethical-legal aspects such as data privacy, this technology is rapidly growing and is likely to revolutionize current medical practice.

Ensino remoto de educação em saúde na pós-graduação em saúde coletiva: possibilidades no contexto da pandemia de covid-19 / Remote teaching of health education in the postgraduate program in collective health: possibilities in the context of the covid-19 pandemic / Enseñanza a distância de educación para la salud en el posgrado en salud colectiva: posibilidades en el contexto de la pandemia del covid-19

O ensino remoto emergencial ocasionou mudanças no processo de ensino-aprendizagem, requisitando criatividade e incorporação de novas estratégias pedagógicas. Aqui, o objetivo é descrever a experiência de ensino-aprendizagem na disciplina educação em saúde, no contexto da pandemia de covid-19. Trata-se de um relato de experiência sobre o ensino remoto de educação em saúde no Programa de Pós-Graduação em Saúde Coletiva da Universidade Estadual do Ceará, no período letivo 2021.1. A disciplina foi ministrada por meio da plataforma Google Meet®, adotando-se estratégias ativas de ensino-aprendizagem. Os conteúdos mostraram--se relevantes. Ademais, a experiência promoveu a articulação teórico-prática, valorizou os saberes prévios dos pós-graduandos e estimulou a interatividade. Buscou-se superar o modelo tradicional de ensino, com vistas a propiciar autonomia e uma aprendizagem significativa. Os desafios encontrados e as possibilidades identificadas permitem a reflexão sobre a práxis docente, no que tange ao estímulo à participação e ao engajamento discente em ambiente virtual, além da incorporação de estratégias ativas de ensino, sobretudo no ensino remoto.

Emergency remote teaching caused changes in the teaching-learning process, requiring creativity and the incorporation of new pedagogical strategies. Here, the objective is to describe the teaching-learning experience in the health education discipline, in the context of the covid-19 pandemic. This is an experience report on remote teaching of health education in the postgraduate program in public health, at the Ceará State University, Brazil, in the 2021.1 academic period. The classes were given using the Google Meet® platform, adopting active teaching-learning strategies. The contents proved to be relevant. Moreover, the experience promoted theoretical-practical articulation, valued the prior knowledge of the postgraduate students and encouraged interactivity. We sought to overcome the traditional teaching model, in order to provide autonomy and a meaningful learning. The challenges experienced and the possibilities identified allow reflection on teaching practice in terms of encouraging student participation and engagement in a virtual environment, in addition to the incorporation of active teaching strategies in especially remote teaching.

La educación remota de emergencia provocó cambios en el proceso de enseñanza-aprendizaje, requiriendo creatividad y la incorporación de nuevas estrategias pedagógicas. El objetivo aquí es describir la experiencia de enseñanza-aprendizaje en la disciplina educación para la salud, en el contexto de la pandemia covid-19. Se trata de un relato de experiencia sobre la enseñanza remota de educación para la salud en el programa de posgrado en Salud Pública, de la Universidad Estadual de Ceará, en el período académico 2021.1. El curso se impartió utilizando la plataforma Google Meet®, adoptando estrategias activas de enseñanza-aprendi-zaje. Los contenidos han demonstrado ser relevantes. Además, la experiencia fomentó la articulación teó-rico-práctica, valoró los conocimientos previos de los estudiantes de posgrado y impulsó la interactividad. Buscamos superar el modelo de enseñanza tradicional, con el propósito de proporcionar autonomía y un aprendizaje significativo. Los desafíos enfrentados y las posibilidades identificadas permiten reflexionar sobre la práctica docente, en relación a incentivar la participación y el compromiso de los estudiantes en un ambiente virtual, además de la incorporación de estrategias activas en la enseñanza remota.

Da superfície para a profundidade: Curva de aprendizado em lifting facial profundo estendido - meus primeiros 100 casos / From Surface to Depth: Learning Curve in Extended Deep Facelift ­ my First 100 Cases

Introdução: O envelhecimento facial é um processo gradual, complexo e multifatorial. É o resultado de mudanças na qualidade, volume e posicionamento dos tecidos. Cirurgiões plásticos têm modificado sua abordagem na cirurgia do rejuvenescimento facial optando pelo plano subaponeurótico (SMAS). O objetivo deste estudo é analisar 100 casos de pacientes operados pela técnica de SMAS profundo, avaliando sua aplicabilidade e eficácia. Método: Foram avaliados 100 pacientes, submetidos a cirurgia plástica facial pela técnica de SMAS profundo - "Deep Smas", e acompanhados por 6 meses. Observou-se a satisfação dos pacientes, número de complicações, número de reoperações, riscos e vantagens da técnica. Resultados: Foram operados 100 pacientes, num período de 3 anos. A idade variou de 41 a 79 anos, sendo 95% sexo feminino. As complicações foram 8 casos (8%) de lesões de ramos do nervo facial, sendo: 4 casos lesão do zigomático, 3 casos de lesão do mandibular e 1 caso de lesão do bucal; houve 1 caso (1%) de queloide retroauricular; 1 caso (1%) de hematoma. Em relação às revisões cirúrgicas, houve 8 casos (8%) de complementação cirúrgica por insatisfação das pacientes. Houve 15% de lesões nervosas entre a 1ª e a 40ª cirurgia, 5% entre a 41ª e a 80ª, e nenhuma lesão entre o 81º e o 100º paciente. Conclusão: O lifting facial profundo ou subSMAS mostrou ser efetivo, proporcionando bons resultados estéticos. Apresenta baixa taxa de recidiva e baixa taxa de morbidade, porém, necessita de uma longa curva de aprendizagem.

Introduction: Facial aging is a gradual, complex, and multifactorial process. It is the result of changes in the quality, volume, and positioning of tissues. Plastic surgeons have modified their approach to facial rejuvenation surgery, opting for the subaponeurotic plane (SMAS). The objective of this study is to analyze 100 cases of patients operated on using the deep SMAS technique, evaluating its applicability and effectiveness. Method: 100 patients were evaluated, undergoing facial plastic surgery using the deep SMAS technique - "Deep Smas", and followed up for 6 months. Patient satisfaction, number of complications, number of reoperations, risks, and advantages of the technique were observed. Results: 100 patients were operated on over 3 years. Age ranged from 41 to 79 years, with 95% being female. The complications were 8 cases (8%) of injuries to branches of the facial nerve, of which 4 cases of zygomatic injury, 3 cases of mandibular injury, and 1 case of buccal injury; there was 1 case (1%) of post-auricular keloid; 1 case (1%) of hematoma. Regarding surgical revisions, there were 8 cases (8%) of surgical completion due to patient dissatisfaction. There were 15% of nerve injuries between the 1st and 40th surgery, 5% between the 41st and 80th, and no injuries between the 81st and 100th patient. Conclusion: Deep facial lifting or subSMAS has proven to be effective, providing good aesthetic results. It has a low recurrence rate and low morbidity rate; however, it requires a long learning curve.

Una revisión sistemática del uso de la inteligencia artificial en la educación / A systematic review of the use of artificial intelligence in education

Introducción. El uso de la inteligencia artificial (IA) en la educación ha sido objeto de una creciente atención en los últimos años. La IA se ha utilizado para mejorar la personalización del aprendizaje, la retroalimentación y la evaluación de los estudiantes. Sin embargo, también hay desafíos y limitaciones asociados. El objetivo de este trabajo fue identificar las principales tendencias y áreas de aplicación de la inteligencia artificial en la educación, así como analizar los beneficios y limitaciones de su uso en este ámbito. Métodos. Se llevó a cabo una revisión sistemática que exploró el empleo de la inteligencia artificial en el ámbito educativo. Esta revisión siguió una metodología de investigación basada en la búsqueda de literatura, compuesta por cinco etapas. La investigación se realizó utilizando Scopus como fuente de consulta primaria y se empleó la herramienta VOSviewer para analizar los resultados obtenidos. Resultados. Se encontraron numerosos estudios que investigan el uso de la IA en la educación. Los resultados sugieren que la IA puede mejorar significativamente la personalización del aprendizaje, proporcionando recomendaciones de actividades y retroalimentación adaptadas a las necesidades individuales de cada estudiante. Conclusiones. A pesar de las ventajas del uso de la IA en la educación, también hay desafíos y limitaciones que deben abordarse, como la calidad de los datos utilizados por la IA, la necesidad de capacitación para educadores y estudiantes, y las preocupaciones sobre la privacidad y la seguridad de los datos de los estudiantes. Es importante seguir evaluando los efectos del uso de la IA en la educación para garantizar su uso efectivo y responsable.

Introduction. The use of artificial intelligence (AI) in education has been the subject of increasing attention in recent years. AI has been used to improve personalized learning, feedback, and student assessment. However, there are also challenges and limitations. The aim of this study was to identify the main trends and areas of application of artificial intelligence in education, as well as to analyze the benefits and limitations of its use in this field. Methods. A systematic review was carried out on the use of artificial intelligence in education, using a literature search research methodology with five stages, based on the Scopus query and the tool for analyzing results with VOSviewer. Results. Numerous studies investigating the use of AI in education were found. The results suggest that AI can significantly improve personalized learning by providing activity recommendations and feedback tailored to the individual needs of each student. Conclusions. Despite the advantages of using AI in education, there are also challenges and limitations that need to be addressed, such as the quality of data used by AI, the need for training for educators and students, and concerns about the privacy and security of student data. It is important to continue evaluating the effects of AI use in education to ensure its effective and responsible use.

Predicting the Need for Blood Transfusions in Cardiac Surgery: A Comparison between Machine Learning Algorithms and Established Risk Scores in the Brazilian Population

ABSTRACT Introduction: Blood transfusion is a common practice in cardiac surgery, despite its well-known negative effects. To mitigate blood transfusion-associated risks, identifying patients who are at higher risk of needing this procedure is crucial. Widely used risk scores to predict the need for blood transfusions have yielded unsatisfactory results when validated for the Brazilian population. Methods: In this retrospective study, machine learning (ML) algorithms were compared to predict the need for blood transfusions in a cohort of 495 cardiac surgery patients treated at a Brazilian reference service between 2019 and 2021. The performance of the models was evaluated using various metrics, including the area under the curve (AUC), and compared to the commonly used Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST) scoring systems. Results: The study found that the model had the highest performance, achieving an AUC of 0.7350 (confidence interval [CI]: 0.7203 to 0.7497). Importantly, all ML algorithms performed significantly better than the commonly used TRACK and TRUST scoring systems. TRACK had an AUC of 0.6757 (CI: 0.6609 to 0.6906), while TRUST had an AUC of 0.6622 (CI: 0.6473 to 0.6906). Conclusion: The findings of this study suggest that ML algorithms may offer a more accurate prediction of the need for blood transfusions than the traditional scoring systems and could enhance the accuracy of predicting blood transfusion requirements in cardiac surgery patients. Further research could focus on optimizing and refining ML algorithms to improve their accuracy and make them more suitable for clinical use.

Aprendizagem baseada em casos clínicos no ensino de genética para medicina / Learning based on clinical cases in the teaching of genetics for medicine

Resumo Introdução: A necessidade premente de formar médicos autônomos e proativos implica novas abordagens didáticas e formas de mediar o conteúdo. Nesse contexto, a utilização de métodos ativos de ensino e aprendizagem pode incrementar o perfil do novo profissional. A Aprendizagem Baseada em Casos (ABC) é uma estratégia fundamentada na capacidade de o estudante relacionar teoria e prática com autonomia e tomada de decisão. A disciplina de genética aborda conteúdos que podem parecer distantes do cotidiano e da prática profissional futura, e, por isso, a necessidade de utilizar estratégias de ensino que facilitem a compreensão da aplicação desse conhecimento na prática médica. Objetivo: O presente trabalho teve por objetivo avaliar a ABC como abordagem pedagógica no processo de ensino-aprendizagem de genética para o curso de Medicina de uma instituição pública. Método: Aplicou-se um protocolo de método ativo composto por nove casos clínicos a 46 estudantes de Medicina da Universidade de Brasília que, posteriormente, foram divididos em nove grupos. Por meio de questionários, avaliaram-se o desempenho e as percepções em relação ao método. Os resultados quantitativos foram analisados por meio do teste t de Student. Resultado: O rendimento do trabalho em grupo foi estatisticamente maior em oito dos nove casos em comparação ao trabalho individual. A atividade foi considerada boa ou muito boa por 76% dos estudantes, e 90% mencionaram que houve aumento da motivação. Além disso, 71,4% destes demonstraram interesse em estudar mais sobre o assunto após a aula, 20% se consideraram capazes de ensinar o assunto a outras pessoas, e 42% avaliaram que acertariam todas ou a maioria das questões caso fossem submetidos a uma nova avaliação. Com relação ao trabalho em equipe, 38% relataram se sentir mais motivados. Por fim, 86% consideraram relevante ou muito relevante a discussão de casos clínicos para a formação profissional. Conclusão: Os resultados demostraram sucesso no uso do método ABC na abordagem de genética, porém apontaram que há dificuldades na utilização de métodos de ensino alternativos à aula expositiva. Apesar disso, fica explícito que a estratégia adotada pode levar à mobilização de conhecimentos prévios em situações da prática profissional.

Abstract Introduction: The pressing need to train autonomous and proactive professionals demands new ways of mediating content. In this context, the use of active teaching and learning methods can improve the profile of the new professional. Case-Based Learning (CBL) is a strategy based on the student's ability to relate theory and practice, with autonomy and decision-making. The discipline of Genetics addresses contents that may seem distant from everyday life and future professional practice, so it is necessary to use teaching strategies that facilitate the understanding of the application of this knowledge in medical practice. Objective: This study aimed to evaluate the CBL as a pedagogical approach in the teaching-learning process of Genetics for Medicine courses in a public institution. Methods: An active methodology protocol that consisted of nine clinical cases was applied to 46 medical students from Universidade de Brasília, who were later divided into nine groups. The performance and perceptions regarding the methodology were evaluated by questionnaires. Quantitative results were analyzed using Student's t test. Results: The performance of group work was statistically higher in 8 of 9 cases compared to individual work. Most students considered the activity good or very good (76%), but approximately half reported no increase in motivation. Moreover, 71.4% felt motivated to learn more about the subject after class and 20% considered they were able to teach the subject to others and 42% assessed they would get all or most of the questions correct if they were submitted to a new assessment. Regarding teamwork, 38% reported feeling more motivated. Finally, 86% considered the discussion of clinical cases relevant or very relevant for professional training. Final considerations: The results show, in general, success in the use of CBL on the study of genetic diseases but point out that there are difficulties in the use of alternative teaching methods to the lecture. Despite this, it is clear that learning based on clinical cases can lead to the mobilization of previous knowledge in situations of professional practice.

Team-Based Learning online: percepção dos graduandos de saúde e influência do perfil comportamental do estudante / Online Team-Based Learning: perception of health undergraduates and influence of the student's behavioral profile

Resumo Introdução: O Team-Based Learning (TBL) é uma metodologia ativa que tem se mostrado efetiva para a formação de profissionais de saúde. Em 2020, devido à pandemia da Covid-19, a aplicação do TBL migrou da modalidade presencial para online síncrona. Objetivos: Este estudo objetivou avaliar a percepção de graduandos de saúde sobre o TBL online e analisar se existe diferença de percepção dessa modalidade entre os grupos de estudantes com níveis distintos de exposição anterior às sessões presenciais e online do método, além de verificar se tal percepção pode ser afetada pelo perfil comportamental do estudante. Método: Trata-se de um estudo observacional, transversal de caráter descritivo-exploratório, comparativo, relacional, de abordagem quantitativa, realizado nos cursos de graduação em Medicina e Enfermagem, entre setembro e dezembro de 2021. Aplicou-se, virtualmente, um questionário sobre os dados sociodemográficos, além dos instrumentos Avaliação da Percepção do Aluno-Team-Based Learning (APA-TBL) e Teste de Perfil Comportamental DISC. Resultados: Dos 241 estudantes participantes, houve predominância do sexo feminino (81%), na faixa etária de 20,8 a 24,4 anos, que já tinham frequentado mais de 10 sessões de TBL presencial (90%) e TBL online (53%). Das 24 questões do APA-TBL, 17 obtiveram índice igual ou superior a 75% na soma das respostas "concordo totalmente"/"concordo", valores considerados como percepção positiva neste estudo. Os alunos com exposição a mais de 10 sessões do TBL online apresentaram uma percepção significativamente mais negativa em três das quatro dimensões do APA-TBL, quando comparados aos menos expostos. O grupo que havia participado de mais de 10 sessões de TBL presencial apresentou uma percepção significativamente mais negativa em apenas uma dimensão do instrumento, quando comparados aos menos expostos. O principal fator DISC encontrado entre os perfis comportamentais dos participantes foi a estabilidade ("S"). Não houve correlação entre o perfil comportamental do aluno e sua percepção sobre o método na versão online. Conclusões: Observou-se uma percepção favorável dos graduandos de saúde sobre o TBL online. A exposição anterior prolongada ao método, tanto no modo online, quanto presencial, impactou negativamente a percepção dos estudantes sobre o TBL online. Não foi evidenciada influência do perfil comportamental do estudante em sua percepção do método.

Abstract Introduction: Team-Based Learning (TBL) is an active methodology that has shown to be effective for the training of health professionals. In 2020, due to the COVID-19 pandemic, TBL utilization migrated from the in-person to the synchronous online mode. Objectives: This study aimed to evaluate the perception of health undergraduate students about online TBL and to analyze whether there is a difference regarding this perception between groups of students with different levels of exposure prior to in-person and online sessions of the teaching method, in addition to verifying whether such perception can be affected by the student's behavioral profile. Method: This is an observational, cross-sectional, descriptive-exploratory level II comparative study with a quantitative approach, carried out in undergraduate Nursing and Medicine courses between September and December 2021. A questionnaire on sociodemographic data was applied virtually, in addition to the Assessment of Student Perception-Team-Based Learning (ASP-TBL) and the DISC Personality Test instruments. Results: Of the 241 participating students, most were females (81%), aged between 20.8 and 24.4 years, who had already attended more than 10 sessions of in-person TBL (90%) and online TBL (53%). Of the 24 ASP-TBL questions, 17 obtained an index equal to or greater than 75% in the sum of the answers "I totally agree"/"I agree", values considered as a positive perception in this study. Students exposed to more than 10 online TBL sessions had a significantly more negative perception in three of the four dimensions of the ASP-TBL, when compared to less exposed students. The group that had participated in more than 10 in-person TBL sessions had a significantly more negative perception in only one dimension of the instrument, when compared to the less exposed ones. The main DISC Personality test factor found among the participants' behavioral profiles was submission ("S"). There was no correlation between the student's behavioral profile and their perception of the method in the online version. Conclusions: There was a favorable perception of health undergraduate students regarding online TBL. Previous prolonged exposure to the method, both online and in-person, represented a significant difference in the students' perception of online TBL. There was no evidence of the influence of the student's behavioral profile on their perception of the teaching method.

Software educativo como herramienta para el aprendizaje de plexos nerviosos somáticos en estudiantes de medicina

Introducción: Las características morfofuncionales de los plexos nerviosos somáticos resulta imprescindible para entender las principales lesiones de estos y la realización del examen físico, por ello este tema se estudia en todas las especialidades de las Ciencias de la Salud. Objetivo: Elaborar un software educativo que facilite el aprendizaje de las características morfofuncionales de los plexos nerviosos somáticos. Métodos: Se realizó una innovación tecnológica para elaborar un software educativo referido a los plexos nerviosos somáticos, dirigido a estudiantes del primer año de medicina. La investigación se desarrolló de septiembre 2021 a febrero 2022, se utilizó el programa CrheaSoft versión 3.1, el software Adobe PhotoShop CS4 para el procesamiento de imágenes y la suite ofimática Microsoft Office 2003 para la elaboración de textos. Resultados: El software quedó estructurado en seis módulos: inicio, temario, juegos, ejercicios, mediateca, complemento y créditos-ayuda, que muestran la información recopilada del tema y permiten la interacción con los estudiantes en todas las actividades docentes en las que se puede utilizar el producto. En la validación por criterio de expertos y de usuario, todos los aspectos fueron evaluados en la categoría de excelente y bien. Conclusiones: La creación de este software educativo constituye una vía para que el estudiante tenga acceso a la información actualizada y científica, organizada sobre las características morfofuncionales de los plexos nerviosos somáticos, que facilite la asimilación de estos contenidos en una etapa en que se han producido cambios en los escenarios docentes y en los planes de estudio de las carreras de las Ciencias de la Salud.

Introduction: Morphological characteristics of the somatic nervous plexuses result very important to understand the main injuries of them and to do the physical examination, that's why this topic is studied in all the specialties of the Health Sciences. Objective: To elaborate an educational software that facilitates the learning process of the characteristic of the somatic nervous plexuses. Methods: A technological innovation to elaborate an educational software related to somatic nervous plexuses for the first year medical students was done. The investigation was performed from September 2021 to February 2021. It was used CrheaSoft program, version 3.1, the software Adobe PhotoShop CS4 to process the imagining and the suite Office 2003 for text writing. Results: The software was structured in six modules: presentation, contents, games, exercises, anatomical images, complements and credits-help, which shows the organized information by contents and the interactions with the students in all the teaching activities where this product could be used. In the validation by expert and user criteria, all the aspects of the software were evaluated in the category of excellent and good. Conclusions: The creation of this educational software constitute a way for the students to get access to the scientific, very well organized and updated information about morphological characteristics of the somatic nervous plexuses, that facilitate the assimilation of this topics at the present where important changes has taken place at the medical schools and the study plans of Health Sciences degrees.

Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

Abstract Introduction: This study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency. Methods: Anonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h0. Residents whose curves reached h0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up. Results: Thirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27-78 [4-132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13-24 [13-24]). Conclusions: The LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.

Impact of reading intervention on the phonological awareness of children with autism spectrum disorder: a systematic review and meta-analysis

Abstract Purpose To review studies that have intervention in reading with impacts on phonological awareness in children with autism spectrum disorder. Research strategies Searches took place until February 2021 in Cochrane, Embase, ERIC (Education Resources Information Center), LILACS (Latin American and Caribbean Health Sciences Literature), PubMed/Medline, Scopus, Web of Science and gray literature databases. Selection criteria The review included experimental studies with preschoolers and schoolchildren with ASD. Two independent reviewers selected the studies and, in case of disagreement, a third reviewer was consulted. Data analysis Joanna Briggs Institute checklists were used for risk of bias. A random effects meta-analysis was performed and the certainty of the evidence was assessed using the GRADE tool. Results Eight studies with some impact on phonological awareness were reviewed. The risk of bias was low and moderate. The certainty of the evidence was low for randomized trials and very low for non-randomised trials. Comparison of pre- and post-therapy on the Preschool Literacy Test (TOPEL) showed that children with ASD improved phonological awareness, with a mean difference between baseline and post-therapy of 6.21 (95% CI = 3.75-8.67; I2 = 0%). Conclusion Shared reading and software activities with words and phrases can alter phonological awareness. These results support further research with larger samples and a detailed description of the intervention to observe its effectiveness in phonological awareness.