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.

Debriefing, a dialogical space for the development of reflective thinking in nursing / Debriefing, un espacio dialogico para el desarrollo del pensamiento reflexivo en enfermería / Debriefing, espaço dialógico para o desenvolvimento do pensamento reflexivo na enfermagem

ABSTRACT Objective: To understand the pedagogical elements necessary for the debriefing to favor the development of reflective thinking. Method: A single case study developed at the Centro de Simulación en Salud of the Escuela de Enfermería of the Universidad de Costa Rica in October 2018. Data were collected through interviews, observation and document analysis. For data analysis, the strategy of theoretical propositions and the construction of explanation technique were used. Results: The data originated two categories: 1) pedagogy of the organization, addressed elements thought by the professor to facilitate the dialogue; 2) facilitation pedagogy, brought elements from the dialogue itself that enrich the discussion, mobilize the group, provoke reflection and engagement. Final considerations: It is essential to include the following as pedagogical elements in order to favor the development of reflective thinking: prior planning, adequate environment, systematization, pedagogical training in facilitating debriefing, openness to dialogue, pedagogical respect, valorization of positive aspects, patience, and motivation.

RESUMEN Objetivo: Comprender los elementos pedagógicos necesarios para que el debriefing favorezca el desarrollo del pensamiento reflexivo. Método: La información sobre el tipo de estudio, muestra, período, lugar de la investigación, recolección y análisis de datos debe presentarse de manera clara y objetiva, sin excesivos detalles. El método debe alinearse con la sección de métodos del artículo completo, brindando información más detallada sobre el diseño del estudio y los procedimientos utilizados. Resultados: Los datos originaron dos categorías: 1) pedagogía de la organización, en que los elementos abordados pensados por el profesor para facilitar el diálogo; 2) pedagogía de la facilitación, en que el trajo elementos del propio diálogo que enriquecen la discusión, movilizan al grupo, provocan la reflexión y el compromiso. Consideraciones finales: Es imprescindible incluir como elementos pedagógicos que favorezcan el desarrollo del pensamiento reflexivo los siguientes: planeamiento previo, ambiente adecuado, sistematización, formación pedagógica en la facilitación del debriefing, apertura al diálogo, respeto pedagógico, valorización de los aspectos positivos, paciencia y motivación.

RESUMO Objetivo: Compreender os elementos pedagógicos necessários para que o debriefing favoreça o desenvolvimento do pensamento reflexivo. Método: Estudo de caso único desenvolvido no Centro de Simulaciónen Salud da Escuela de Enfermería da Universidad de Costa Rica em outubro de 2018. Os dados foram coletados por meio de entrevistas, observação e análise documental. Utilizaram-se a estratégia de proposições teóricas e a técnica de construção de explanação para a análise dos dados. Resultados: Os dados originaram duas categorias: 1) pedagogia da organização, a qual abordou elementos pensados pelo docente para facilitar o diálogo; 2) pedagogia da facilitação, a qual trouxe elementos do próprio diálogo que enriquecem a discussão, mobilizam o grupo, provocam a reflexão e o engajamento. Considerações finais: Torna-se imprescindível incluir como elementos pedagógicos que favoreçam o desenvolvimento do pensamento reflexivo os seguintes: planejamento prévio, ambiente adequado, sistematização, formação pedagógica em facilitação de debriefing, abertura ao diálogo, respeito pedagógico, valorização do positivo, paciência e motivação.

Modificações do feedback auditivo e seus efeitos sobre a voz de indivíduos adultos: uma revisão de escopo / Modifications of auditory feedback and its effects on the voice of adult subjects: a scoping review

RESUMO Introdução A percepção auditiva da voz e sua produção envolvem o feedback auditivo, as pistas cinestésicas e o sistema de feedforward, os quais produzem efeitos distintos para a voz. Os efeitos Lombard, Sidetone e o Pitch-Shift-Reflex são os mais estudados. O mapeamento de experimentos científicos sobre as modificações do feedback auditivo para o controle motor da voz possibilita examinar a literatura existente sobre o fenômeno e pode contribuir para o treinamento ou terapias da voz. Objetivo Mapear os experimentos e resultados das pesquisas com manipulação do feedback auditivo para o controle motor da voz de indivíduos adultos. Método Revisão de escopo seguindo o Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) para responder à pergunta: "Quais os métodos de investigação e principais achados das pesquisas sobre a manipulação do feedback auditivo no automonitoramento da voz de indivíduos adultos?". O protocolo de busca foi baseado na estratégia mnemônica População, Conceito e Contexto (PCC). A população são os indivíduos adultos; o conceito é a manipulação do feedback auditivo e o contexto é o controle motor da voz. Os artigos foram pesquisados nas bases de dados: BVS/ Biblioteca Virtual em Saúde, MEDLINE/Medical Literature Analysis and Retrieval Sistem on-line, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS e WEB OF SCIENCE. Resultados Foram encontrados 60 artigos, sendo 19 da temática do Efeito Lombard, 25 do efeito Pitch-shift-reflex, 12 do efeito Sidetone e quatro sobre o efeito Sidetone/Lombard. Os estudos são concordantes que a inserção de um ruído que mascara o feedback auditivo provoca um aumento na intensidade de fala do indivíduo e que a amplificação do feedback auditivo promove a redução do nível de pressão sonora na produção da voz. Observa-se uma resposta reflexa à mudança de tom no feedback auditivo, porém, com características individuais em cada estudo. Conclusão O material e método dos experimentos são distintos, não há padronizações nas tarefas, as amostras são variadas, muitas vezes reduzidas. A diversidade metodológica dificulta a generalização dos resultados. Os principais achados das pesquisas a respeito o feedback auditivo sobre o controle motor da voz confirmam que, na supressão do feedback auditivo, o indivíduo tende a aumentar a intensidade da voz. Na amplificação do feedback auditivo, o indivíduo diminui a intensidade e tem maior controle sobre a frequência fundamental e, nas manipulações da frequência, o indivíduo tende a corrigir a manipulação. Os poucos estudos com sujeitos disfônicos mostram que eles se comportam diferentemente dos não disfônicos.

ABSTRACT Introduction The auditory perception of voice and its production involve auditory feedback, kinesthetic cues and the feedforward system that produce different effects for the voice. The Lombard, Sidetone and Pitch-Shift-Reflex effects are the most studied. The mapping of scientific experiments on changes in auditory feedback for voice motor control makes it possible to examine the existing literature on the phenomenon and may contribute to voice training or therapies. Purpose To map experiments and research results with manipulation of auditory feedback for voice motor control in adults. Method Scope review following the Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) to answer the question: "What are the investigation methods and main research findings on the manipulation of auditory feedback in voice self-monitoring of adults?". The search protocol was based on the Population, Concept, and Context (PCC) mnemonic strategy, in which the population is adult individuals, the concept is the manipulation of auditory feedback and the context is on motor voice control. Articles were searched in the databases: BVS/Virtual Health Library, MEDLINE/Medical Literature Analysis and Retrieval System online, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS and WEB OF SCIENCE. Results 60 articles were found, 19 on the Lombard Effect, 25 on the Pitch-shift-reflex effect, 12 on the Sidetone effect and four on the Sidetone/Lombard effect. The studies are in agreement that the insertion of a noise that masks the auditory feedback causes an increase in the individual's speech intensity and that the amplification of the auditory feedback promotes the reduction of the sound pressure level in the voice production. A reflex response to the change in pitch is observed in the auditory feedback, however, with particular characteristics in each study. Conclusion The material and method of the experiments are different, there are no standardizations in the tasks, the samples are varied and often reduced. The methodological diversity makes it difficult to generalize the results. The main findings of research on auditory feedback on voice motor control confirm that in the suppression of auditory feedback, the individual tends to increase the intensity of the voice. In auditory feedback amplification, the individual decreases the intensity and has greater control over the fundamental frequency, and in frequency manipulations, the individual tends to correct the manipulation. The few studies with dysphonic individuals show that they behave differently from non-dysphonic individuals.

El rol de la retroalimentación en la toma de decisiones bajo riesgo en niños/as y adolescentes con Trastorno por Déficit de Atención e Hiperactividad

Los estudios en niños/as y adolescentes con Trastorno por Déficit de Atención e Hiperactividad (TDAH) suelen evidenciar dificultades en la toma de decisiones, vinculadas con comportamientos más riesgosos. El objetivo del presente estudio fue analizar y comparar el proceso de Toma de Decisiones Bajo Riesgo (TDBR) en niños/as y adolescentes con TDAH, considerando los tipos de retroalimentaciones utilizadas. Los tipos de retroalimentaciones se refieren al procesamiento de las consecuencias de las decisiones de los ensayos previos y a su influencia en las elecciones presentes y futuras. Se realizó un estudio descriptivo comparativo con un diseño ex post facto retrospectivo con dos grupos. La muestra estuvo compuesta por 100 niños/as y adolescentes de 8 a 15 años (68 niños y niñas de 8 a 11 años y 32 adolescentes de 12 a 16 años), divididos en grupo clínico y grupo control, pareados por sexo y edad. Para evaluar la TDBR se administró el Test de los Dados (The Game of Dice Task, GDT), la cual es una prueba informatizada en la que se deben tomar decisiones apostando para ganar puntos. Para analizar los tipos de retroalimentación se consideraron ocho tipos posibles. Los resultados evidenciaron un comportamiento con una tendencia a elegir opciones de riesgo en la población con TDAH, tanto en el tipo de elecciones realizadas como en la forma en que utilizan la retroalimentación al ganar o al perder, no vinculándose necesariamente con decisiones desfavorables. Estos hallazgos podrían contribuir al desarrollo de programas de intervención destinados a disminuir las dificultades en la toma de decisiones en personas con diagnóstico de TDAH.

Studies on children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) often show difficulties in decision-making, linked to riskier behaviors. The aim of the present study was to analyze and compare the process of Decision Making Under Risk (DMUR) in children and adolescents with ADHD considering the types of feedback used. Feedback types refer to processing the consequences of previous trial decisions and their influence on present and future choices. A comparative descriptive study was carried out with a retrospective ex post facto type design with two groups. The sample consisted of 100 boys, girls and adolescents from 8 to 15 years old, (68 boys and girls from 8 to 11 years old and 32 adolescents from 12 to 16 years old), divided into a clinical group and a control group paired by sex and age. To evaluate the DMUR, the Game of Dice Task (GDT) was administered, which is a computerized test in which betting decisions must be made to earn points. And to analyze the types of feedback, eight possible types were considered. The results showed a behavior with a tendency to choose risky options in the population with ADHD, both in the type of choices made and in the way, they use feedback when winning or losing, not necessarily linked to unfavorable decisions. These findings could contribute to the development of intervention programs aimed at reducing the difficulties in decision-making in people diagnosed with ADHD.

Assessment of Knowledge, Attitude and Practice related to Tuberculosis among Rural and Urban Community of North India

Tuberculosis is known as one of the long-standing and dominating health problems affecting people and the extent further escalates in a developing country like India. A pre-evaluated feedback structured questionnaire was validated and adopted to get their quantitative data from 424 respondents. In the present study urban respondents (60.8%) gave affirmative responses regarding awareness of TB, especially with mobile media as their major source of information, followed by information from healthcare workers. Rural respondents were less expressed and deficient on knowledge of TB transmission and preventive methods. Prevention practices toward TB are claimed to be high in urban population because 79.48% believed that early diagnosis, prompt treatment and avoiding poor hygiene and crowded environment are effective strategies to cease the transmission of TB. Effective preventive and informative strategies should be employed in rural border areas to make up for the knowledge gap found among rural and urban populations in this study.

Physiology teaching methodology – Perspective of undergraduate medical students

Background: Proper understanding of concepts of physiology forms basis of good clinical practice. To make the lectures in physiology more interesting and understanding, one has to review the teaching methods at regular intervals. Aims and Objectives: This study is designed to get feedback regarding teaching methods in physiology from MBBS students of Government Medical College, Kozhikode, to make teaching more effective. Materials and Methods: Two hundred randomly selected students who successfully completed 1st-year MBBS are included in the study group. The standard questionnaire is shared to study group through Google forms and adequate time is given to record their responses. Descriptive statistics are used. Frequency is expressed in percentage. Results: Most of students prefer interactive teaching methodologies such as group discussion as their preferred mode of learning rather than conventional didactic lectures in whole batch. Students also like to have integration with other subjects and early clinical exposure to understand the concepts precisely. Conclusion: Teaching in small groups with proper integration and alignment with other subjects will make maximum results rather than the traditional teacher centered medical education. Periodic review of teaching methods is very much essential to make the subject more interesting.

Perspectives of Teachers at Medical Colleges Across India regarding the Competency based Medical Education Curriculum – A Qualitative, Manual, Theoretical Thematic Content Analysis

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers’ perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross?sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n = 192). The data collection was done using Google forms online survey platform on teachers’ perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum’s implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an “Indian Medical Graduate” for the needs of todays’ society.

Students’ reflection on immediate feedback during formative assessment

Background: Providing immediate feedback to students has shown improvement in students’ knowledge, understanding, and confidence as it helps in identifying lacunae and loopholes in learning process. Despite the usefulness of feedback, common complaint from students is that they usually do not receive feedback immediately in their learning process. We also face similar situation with our students in institute. The aim of this study was to find out effect of giving immediate feedback and explore the views of medical students on immediate feedback during formative assessment. Aims and Objectives: The aims of this study were to evaluate the effect of immediate feedback on the medical students’ learning in medical education. Materials and Methods: The study was conducted in Department of Physiology, GMERS Medical College, Valsad on 183 students of 1st MBBS after ethical approval. Two types of modules were prepared on using “Hot Potatoes” software version 6.3. Module-1: Test 1 without feedback: consist of 20 MCQs and Module-2: Test 2 with feedback: consist of 20 MCQs, provide immediate feedback for each option of MCQ. Two modules were given one by one on WhatsApp group on mobile phone. Reflection writing and feedback from students were taken after that. Results: The qualitative data collected provided important information about the immediate feedback. Feedback responses of students on the questionnaire were analyzed using Likert scale. The Likert scale values were in strongly agree/agree part for Module-2 (with feedback). The students believed that immediate feedback was very helpful in clearing concepts, finding out lacunae, improvement in confidence, and self-learning. An excellent way for self-assessment and improved their deeper understanding of content areas. The students enjoyed innovative way of learning compared to conventional learning. Conclusion: Immediate feedback using this type of feedback modules should be implemented to improve students’ knowledge, understanding, memory, and confidence and can be used as self-directed learning tool.

A study to assess feedback on existing teaching and evaluation methods in pharmacology among undergraduate students

Background: Pharmacology, being both basic and applied science, is indeed the foundation of rational therapy. Pharmacology education needs constant reform and reorganization to review and adapt learning and teaching methods. It can be better achieved using student feedback. Aims and Objectives: The study was designed to obtain and evaluate the feedback of students on various teaching and evaluation methods in pharmacology. Materials and Methods: It is a cross-sectional study. A pre-tested questionnaire used for the purpose of this study. After obtaining permission from the Institutional Ethics Committee, a questionnaire was given to the students of Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery, Bachelors in science (Nursing), and Allied Health Sciences (AHS) courses. Students who completed pharmacology as a part of their course curriculum were enrolled in the study. Results: A total of 273 students participants took part in our study. The most common age was 20 years (147 students, 53.8%), more females (153 students, 56%), and the majority of them were MBBS students (153 students, 56%). Most of the students found that knowledge of chemotherapy will be useful during the post-course internship (26.4%) and the knowledge of autocoids will be the least useful in clinical practice (1.1%). Students preferred more than studying method for pharmacology (37.4%). Conclusion: An effective teaching program is beneficial to comprehend pharmacology. Any effort at obtaining constant feedback from students makes our methodologies more relevant and interesting. Any worthwhile effort in this direction will lead to more rational prescribers and/or health-care professionals in the future.

Teleintervenção guiada por videofeedback à família de uma criança usuária de implante coclear: estudo de caso / Videofeedback-guided teleintervention for the family of a child with a cochlear implant: a case study

RESUMO Intervenções para a capacitação parental de famílias de crianças com deficiência auditiva, incluindo as usuárias de implante coclear, são apontadas como otimizadoras em seus resultados de desenvolvimento. Neste estudo de intervenção de caso único, temos por objetivos descrever o uso do videofeedback em ambiente remoto, bem como identificar a sua efetividade, a partir da análise da interação da mãe e criança, tanto para os comportamentos comunicativos da mãe como para os comportamentos da linguagem receptiva e expressiva da criança. Medidas pré e pós-intervenção foram realizadas, a partir da análise de vídeos de interação da mãe com a criança, por juízes cegos, bem como pela aplicação de instrumentos de avaliação da criança e da mãe. Foram realizadas 13 sessões, sendo 3 de avaliação nos momentos pré e pós-intervenção e 10 sessões de teleconsulta em que se empregou a ferramenta de videofeedback com a mãe. Os dados foram analisados de forma descritiva e inferencial, por meio do método JT, que determinou o Índice de Mudança Confiável (IMC) e a Significância Clínica. Houve mudança positiva confiável na linguagem receptiva e expressiva da criança, bem como mudança positiva confiável e mudança clínica significativa na interação da mãe com a criança após as 10 sessões de intervenção remota com videofeedback. A partir das mudanças confiáveis observadas neste estudo, apresentamos este modelo (Televideofeedback), como potencial para otimizar os recursos e esforços para o sucesso terapêutico na reabilitação auditiva infantil, o qual deve ser estudado em pesquisas com método rigoroso, para a ampla recomendação de seu uso.

ABSTRACT Interventions for parental training for families of hard of hearing children, including cochlear implant users, are identified as optimizing their developmental outcomes. In this single-case intervention study, we aim to describe the use of videofeedback in a remote environment, as well as to identify its effectiveness, based on the analysis of mother-child interaction, both for the mother's communicative behaviors and for the behaviors of the mother, receptive and expressive language of the child. Pre- and post-intervention measurements were performed, based on video analysis of the mother's interaction with the child, by blind judges, as well as through the application of assessment instruments for the child and the mother. There were 13 sessions, 3 of which were for evaluation before and after the intervention and 10 of teleconsultation sessions in which the videofeedback tool was used with the mother. Data were analyzed descriptively and inferentially, using the JT method, which determined the Reliable Change Index (BMI) and Clinical Significance. There was reliable positive change in the child's receptive and expressive language, as well as reliable positive change and clinically significant change in mother-child interaction after the 10 sessions of remote videofeedback intervention. Based on the reliable changes observed in this study, we present this model (televideofeedback) as a potential to optimize resources and efforts for therapeutic success in children's auditory rehabilitation, which should be studied in research with a rigorous method, for the broad recommendation of its use.

Construção de curso sobre Mini-CEX na modalidade de ensino a distância para preceptores de residência médica / Construction of a course on Mini-CEX in the distance learning modality for medical residence preceptors

Resumo Introdução: A avaliação é primordial no processo de ensino-aprendizagem do médico residente. O Mini-CEX é considerado um instrumento apropriado para realizar uma avaliação formativa, permitindo um feedback educacional estruturado. Nesse contexto, os preceptores de residência precisam estar em contínuo processo de capacitação para melhor direcionar os seus residentes, e uma forma viável de capacitação é por meio do ensino a distância (EaD). Objetivo: Este estudo teve como objetivos desenvolver e validar um curso na modalidade de EaD sobre Mini-CEX para preceptores da residência em mastologia. Método: Trata-se de desenvolvimento e validação de um produto técnico-educacional no formato de curso de capacitação e na modalidade de EaD. No processo de validação de conteúdo do produto, utilizou-se a técnica de grupo de consenso. A validação semântica foi realizada através de questionário de validação aplicado aos preceptores envolvidos na residência em mastologia. Resultado: Foi elaborado e validado um curso autoinstrucional e sem mediação, com carga horária total de duas horas. O curso teve aprovação do público-alvo por apresentar um escore médio global de 98% de satisfação e um alfa de Cronbach igual a 0,8. Conclusão: O curso desenvolvido e validado sobre Mini-CEX apresenta-se como opção relevante para a formação de preceptores de residência médica em mastologia, podendo se estender para qualquer serviço de residência médica. Ressalta-se que o curso na modalidade de EaD favorece a adesão do público-alvo apresentando um formato acessível para fortalecer o conhecimento sobre o tema, além de incentivar os preceptores a utilizar a ferramenta de avaliação educacional.

Abstract Introduction: Assessment is paramount in the resident physician's teaching-learning process. The Mini-CEX is considered an appropriate instrument to carry out formative assessment, allowing structured educational feedback. In this context, residency preceptors need to undergo a continuous training process to better prepare their residents, and a viable form of training is using Distance Education (EaD). Objective: To develop and validate a Distance Education (EaD) course on Mini-CEX for residency preceptors in Mastology. Method: Development and validation of a technical-educational product, in the format of a training course and in the Distance Education modality (EaD). The consensus group technique was used in the product content validation process. Semantic validation was carried out through a validation questionnaire applied to the preceptors involved in the residency program in Mastology. Results: A self-instructional and unmediated course was designed and validated, with a total workload of 02 (two) hours. The course was approved by the target audience, as it had an overall average score of 98% satisfaction and a Cronbach's alpha equal to 0.8. Conclusions: The course developed and validated on Mini-CEX presents itself as a relevant option for the training of medical residency preceptors in Mastology and can be extended to any medical residency service. It should be noted that the Distance Education (EaD) course favors the adherence of the target audience, with an accessible format to strengthen knowledge on the subject, in addition to encouraging preceptors to also use the educational evaluation.

Efecto de la retroalimentación visual sobre la velocidad de la marcha después de un accidente cerebrovascular: diseño de caso único / Effects of Visual Feedback on Walking Speed for Stroke Patients: Single-case Design

Introducción. La recuperación de la marcha es uno de los principales objetivos en rehabilitación después de un ACV. Basados en los principios de aprendizaje motor, se han desarrollado nuevas estrategias en neurorrehabilitación basadas en la práctica repetitiva, orientada a la tarea y la retroalimentación. Esto último ha demostrado ser una de las variables clave para el entrenamiento, por su fácil obtención y manipulación. Sin embargo, aún no existen estudios concluyentes que permitan identificar el efecto real de esta variable y su influencia en la recuperación y el desempeño funcional de la marcha. Objetivo. Determinar el efecto de la retroalimentación visual sobre la velocidad de la marcha después de un accidente cerebrovascular en adultos con estadios subagudos y crónicos. Metodología. Diseño de caso único de línea de base múltiple, aleatorio no concurrente de cuatro participantes. Se evaluó la velocidad de la marcha determinando las diferencias en el nivel, la tendencia, la estabilidad de los datos y la no superposición de datos mediante el análisis visual basado en la documentación técnica para diseños de caso único de la What Works Clearinghouse. Resultados. Cuatro participantes con rango de edad de 19 a 73 años fueron incluidos en el estudio. El cambio en el nivel para todos los participantes demostró un incremento en los valores de la velocidad de la marcha después de la introducción de la intervención (media: 0.76 m/s). El análisis visual de la tendencia estimó aceleración para la línea de intervención para tres participantes. Los datos en la fase de base e intervención cumplieron el criterio de estabilidad medido con el método de banda de dos desviaciones estándar (media: 0.05 m/s); los patrones de cambio demostraron efecto inmediato con mejoría gradual durante la intervención para los participantes 1, 3 y 4. El porcentaje de no superposición de datos mostró efectividad de la intervención para tres de los participantes (PND >91.67%). Conclusiones. Los hallazgos presentados en este estudio representan un aporte científico que respalda la pertinencia del uso y aplicación de los principios de aprendizaje motor para el desarrollo de nuevas estrategias en rehabilitación motora. Sin embargo, este estudio constituye un primer paso para realizar estudios más robustos que incluyan replicación de las fases en el estudio y la evaluación del seguimiento para determinar la permanencia de los efectos a largo plazo.

Introduction. Gait recovery is one of the main goals in post-stroke rehabilitation. Based on the principles of motor learning, new strategies have been developed in neurorehabilitation based on repetitive, task-oriented practice, and feedback. The latter has proven to be one of the most critical variables for training, because it is easy to obtain and manipulate. However, there are still no conclusive studies to identify the real effect of this variable and its influence on recovery and functional gait performance. Objective. To determine the effect of visual feedback on gait speed after stroke in adults with subacute and chronic stages.Methodology. Single-case, multiple baseline, non-concurrent randomized, and four-participant design. Gait velocity was assessed by determining differences in level, trend, data stability, and nonoverlapping data using visual analysis based on technical documentation for single-case designs from the What Works Clearinghouse.Results. Four participants ranging in age from 19 to 73 years were included in the study. The change in level for all participants demonstrated an increase in gait velocity values after the introduction of the intervention (mean: 0.76 m/s). Visual trend analysis estimated acceleration for the intervention line for three participants. The data in the baseline and intervention phase met the stability criterion measured with the two standard deviation band method (mean: 0.05 m/s); patterns of change demonstrated immediate effect with gradual improvement during the intervention for participants 1, 3, and 4. The percentage of nonoverlapping data showed effective-ness of the intervention for three of the participants (PND >91.67%).Conclusions. The findings presented in this study represent a scientific contribution that supports the relevance of the use and application of motor learning principles for the development of new strategies in motor rehabilitation. However, this study constitutes a first step towards more robust studies that include replication of the phases in the study and follow-up evaluation to determine the permanence of long-term effects.

Procesamiento sensorial en menores de seis años con trastorno específico del lenguaje

Introducción: El procesamiento sensorial determina e influencia el nivel de desarrollo que presentan los individuos en la infancia y cuando se afecta alguno de los sistemas que lo integran, se alteran dominios del desarrollo que impiden a los niños desenvolverse de manera adecuada en su entorno. Objetivos: Describir y comparar el procesamiento sensorial de los niños con trastorno específico del lenguaje y con desarrollo típico del lenguaje. Métodos: La muestra estuvo conformada por 60 niños con edades de 4 a 5 años de la escuela especial de lenguaje San Clemente, asignados a dos grupos de acuerdo con la presencia o ausencia de trastorno específico del lenguaje. El procesamiento sensorial se evaluó mediante la escala de procesamiento sensorial. Se evaluó el tipo de distribución de las variables de la escala para su posterior análisis. Resultados: Los niños con trastorno específico del lenguaje obtuvieron 275 puntos y se ubicaron por debajo del puntaje de corte, en cambio los menores con desarrollo típico obtuvieron 309 puntos y se situaron por sobre el puntaje de corte. Es decir, los niños con trastorno específico del lenguaje presentaron un procesamiento sensorial más bajo en comparación con los niños que poseen desarrollo típico del lenguaje con diferencias significativas en el sistema auditivo y propioceptivo. Conclusiones: Los niños con trastorno específico del lenguaje exhiben un desempeño más bajo en tareas de procesamiento sensorial, es por ello, que este último debe ser considerado en la evaluación y diagnóstico de niños con este trastorno para generar un abordaje más integral.

Introduction: Sensory processing determines and influences the level of development presented by individuals in childhood and when any of the systems that integrate it are affected. Developmental domains are altered and they prevent children from developing adequately in their environment. Objectives: To describe and compare sensory processing in children with specific language impairment and typical language development. Methods: The sample consisted of 60 children aged 4 to 5 years from the San Clemente Special Language School, whom were assigned to two groups according to the presence or absence of specific language disorder. Sensory processing was assessed using the sensory processing scale. The type of distribution of the scale variables was evaluated for further analysis. Results: Children with specific language disorder obtained 275 points and were below the cut-off score, while children with typical development obtained 309 points and were above the cut-off score. That is, children with specific language disorder have lower sensory processing compared to children with typical language development with significant differences in the auditory and proprioceptive system. Conclusions: Children with specific language disorder show lower performance in sensory processing tasks, which is why the latter should be considered in the evaluation and diagnosis of children with this disorder to generate a more comprehensive approach.

Activation characteristics of motor cortex during mirror visual feedback based on electroencephalography / 中国康复理论与实践

ObjectiveTo explore the activation of motor cortex and brain lateralization of healthy male subjects during mirror visual feedback (MVF) of dominant and non-dominant hands. MethodsFrom March to September, 2021, 17 right-handed male subjects were recruited in Shenyang Sport University. The eegoTMmylab electroencephalography (EEG) system was applied to acquire the EEG and surface electromyography (sEMG) signals of digital extensor muscle during MVF. The subjects were completed unilateral finger stretching exercise, including left/right hand MVF and left/right hand visual feedback (VF). Each paradigm was repeated 80 trials, and the four paradigms were divided into two experiments, with one week between each experiment. The time-domain characteristics of sEMG signals and the time-frequency characteristics of α-band (8 to 13 Hz) and β-band (13 to 20 Hz) EEG signals which were closely related to motion were analyzed. Activation and asymmetry of motor cortex during MVF in dominant and nondominant hands were measured with event-related desynchronization/synchronization (ERD/ERS) and asymmetric index (AI). ResultsWhen the relaxed hand was right hand, the sEMG amplitude of digital extensor muscle were more in MVF and VF than in resting state (P < 0.05). In α bands, the main effect of training state on ERD/ERS was significant (F = 14.125, ηp2 = 0.469, P = 0.002), and it was higher in MVF than in VF. In β band, the main effect of training state on ERD/ERS was significant (F = 9.704, ηp2 = 0.378, P = 0.007), the interaction effect of moving hand and training state was significant on ERD/ERS (F = 8.014, ηp2 = 0.334, P = 0.012); for VF, ERD/ERS was higher in right hand movement than in left hand movement (F = 7.267, ηp2 = 0.312, P = 0.016); for right hand movement, ERD/ERS was higher in MVF than in VF (F = 17.530, ηp2 = 0.523, P = 0.001). At the position of C4 electrode, ERD/ERS was higher in right hand movement than in left hand movement under VF (t = -3.201, P = 0.006, Cohen's d = 0.776), and ERD/ERS was higher in MVF than in VF under right hand movement (t = -4.060, P = 0.001, Cohen's d = 0.985). Main effect of training state was significant on AI at β band (F = 5.796, ηp2 = 0.266, P = 0.028), and it was higher in MVF than in VF. ConclusionMVF may improve the activity of motor cortex neurons on the ipsilateral side of the motor hand through recruitment of frontal and parietal mirror neurons and reduction of interhemispheric and intracortical inhibitory activities, and it is more effective for the dominant hand training.

Yun shou tai chi with visual feedback can improve the balance of stroke survivors / 中华物理医学与康复杂志

Objective:To observe any effect of Yun shou tai chi training with visual feedback on the balance of persons who have survived a stroke.Methods:Fifty-six stroke survivors were randomly divided into an observation group and a control group, each of 28. Both groups were given routine balance function training, while the observation group was additionally given Yun shou tai chi training with visual feedback. Before and after the four weeks of training, the subjects′ balance and posture were evaluated using a Nomex visual feedback balance system. Lower limb strength was evaluated with a microFET2 portable muscle strength tester. The Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), 10-metre walk times (10MWTs) and the modified Barthel Index (MBI) were also applied.Results:After the training the average BBS, TUGT, 10MWT and MBI results of the observation group had improved significantly. Among the control group only TUGT times and MBI scores had improved significantly, but even then the average MBI score of the observation group was significantly higher. The training improved the strength of the trainees′ quadriceps femoris (QUA), tibialis anterior (TA) and gastrocnemius (GAS) on the hemiplegic side. Their hamstrings and GAS on the non-hemiplegic side were also significantly stronger, on average. The improvement in the QUA of the hemiplegic side in the observation group was significantly better than the control group′s average improvement. The path length (PL) and the covered area (CA) in the observation group had decreased significantly after the training, while among the controls only the CA had decreased significantly. The average PL in the observation group was therefore significantly shorter than in the control group.Conclusion:Yun shou tai chi training with visual feedback can promote the recovery of balance function after a stroke. Such training is worthy of clinical promotion and application.

Combining vibroacoustic therapy with audio-visual feedback can improve the swallowing and the emotional state of survivors of a brainstem stroke / 中华物理医学与康复杂志

Objective:To observe any effect of combining vibroacoustic therapy with audio-visual feedback on the swallowing and the emotional state of persons with a swallowing disorder after a brainstem stroke.Methods:Fifty brainstem stroke survivors with dysphagia were randomly divided into a control group and a combination group, each of 25. In addition to routine swallowing function training, the control group received additional direct feeding training, while the combination group was provided with vibroacoustic feeding training and swallowing stimulation from an animated audio-visual presentation. Before and after the treatment, the subjects′ swallowing function was quantified using the Standard Swallowing Assessment (SSA) scale and the Gugging swallowing screen (GUSS). The Positive and Negative Emotions Scale (PNAS) was used to quantify their emotional state.Results:After the treatment the average SSA scores of both groups had decreased significantly, while the average GUSS and PNAS scores had increased significantly. The average improvements in all three measures were significantly greater in the combination group than in the control group.Conclusion:In addition to routine swallowing function training, feeding training applying vibroacoustics and audio-visual stimulation can significantly improve the feeding function and emotional state of brainstem stroke survivors with dysphagia.

Observational study on improvement of hypotension in hemodialysis with blood volume feedback control system / 中华肾脏病杂志

Objective:To study the effect of blood volume feedback control system on improving intradialytic-hypotension (IDH) in maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. Thirty MHD patients with recurrent IDH in the Dialysis Center of the First Affiliated Hospital of Zhejiang University School of Medicine from March 2021 to March 2022 were selected. A self-control study was conducted in MHD patients. The patients were treated with routine hemodialysis in both baseline phase (A1) and reversal phase (A2), while with hemodialysis under the blood volume feedback control system in intervention phase (B). Each phase lasted for 4 weeks (12 hemodialysis sessions). The average occurrences of IDH and IDH-related adverse events (IDH-RAE, stopping dehydration for more than 10 minutes or getting off the hemodialysis machine 10 minutes earlier due to IDH) of each patient between phase A1, B, and A2 were calculated and compared. In a total of 1 080 dialysis records, a logistic regression analysis model was established with age, sex and intervention as independent variables and with the occurrence of IDH-RAE as the outcome.Results:A total of 30 eligible patients were included in the study, including 14 males (46.7%) and 16 females (53.3%), aged 63.0 (56.5, 72.5) years old, with a median dialysis age of 84.0 (37.2, 120.0) months. The average times of IDH in 30 MHD patients decreased from 1.17 (0.83, 1.67) in stage A1 (before intervention) to 0.33 (0.25, 0.58) in stage B (after intervention) ( P<0.05). The frequency of IDH-RAE decreased significantly from 0.29 (0.19, 0.47) in stage A1 to 0.17 (0,0.25) in stage B ( P<0.05). Logistic regression analysis results indicated that the use of blood volume feedback control system reduced the risk of IDH-RAE by 53% ( OR=0.47, 95% CI 0.34-0.64, P<0.001). Conclusions:The application of blood volume feedback control system can effectively reduce the occurrences of IDH and the risk of IDH-RAE in MHD patients.

Thyroid hormone sensitivity and obesity phenotype in euthyroid subjects / 中华内分泌代谢杂志

Objective:To explore the relationship between thyroid hormone sensitivity and obesity phenotype in people with normal thyroid function.Methods:In this retrospective study, 6155 euthyroid subjects who underwent a health check-up in the First Hospital of China Medical University between January 2017 and December 2018 were included. Participants were categorized into four obesity phenotypes according to body mass index and metabolic status. Thyroid Feedback Quantile-based Index(TFQI), Parametric TFQI, free triiodothyronine to free thyroxine ratio(FT 3/FT 4), and sum activity of peripheral deiodinases(SPINA-GD) were calculated to evaluate thyroid hormone sensitivity. Results:Compared with metabolically healthy non-obese(MHNO) phenotype, the subjects with metabolically healthy obese(MHO) or metabolically unhealthy obese(MUO) phenotype showed higher FT 3/FT 4ratio. Metabolically unhealthy non-obese(MUNO) and MUO subjects showed lower TFQI. After adjusting for confounders, FT 3/FT 4ratio was positively associated with MHO( OR 1.18, 95% CI 1.11-1.26) and MUO phenotype( OR 1.28, 95% CI 1.19-1.39). With 1 s increase of TFQI, the OR for MUNO phenotype was 0.77(95% CI 0.64-0.94). The results of Parametric TFQI and SPINA-GD were similar to TFQI and FT 3/FT 4ratio, respectively. Conclusion:In euthyroid individuals, thyroid hormone sensitivity was positively associated with increased risk for unhealthy obesity phenotypes.

Exploration and practice of Autopsy and Accident Authentication case seminar / 中华医学教育探索杂志

This article discusses the design and implementation strategy of Autopsy and Accident Authentication case seminar, with the aim of linking pathology to clinic medicine, theory to practice, and cultivating and improving the thinking ability of analyzing and solving problems for medical students in their medical study. The article investigates the effects and feedback of six rounds of classes, reports three aspects as strengthening the systemic understanding of basic medicine, improving the application and thinking ability, and promoting the thinking of medical humanism, and also discusses the teaching effects, students' feedback, and the significance and existing defects of the seminar.

Online Classes Design and Delivery Based on Student Responses

Background : COVID-19 has made a series changes in all system of life especially in education. As a result, education has changed dramatically with the distinctive rise of e-learning. The present study was aim to examine the preference and perception of MBBS student on newly introduced online live video classes. Methods:An online questionnaire survey consisting of closed and open-ended questions on nine different categories such as accessing online video content, previous experience with online learning, interaction with video lectures addressing the content, duration, visualize, timings and screen size, perceived learning experience, the online content learning assessment methods and the experience with the online learning management system.Two hundred and thirteen undergraduate medical students were participating in this study. And it was conducted by the large medical institution in Andhra Pradesh. Results: The e-learning methods were encouraged and its gaining popularity among the medical students and faculty. Our analysis shown 97.7% students were highly satisfied and 2.3% were not satisfied with online classes on comparison to the traditional methods of learning. Conclusions:The teaching method and teachers support are the pivotal elements which enable online learning experience with a mutual relationship. Furthermore, the usefulness and acceptability of e-learning among medical students as a part of their curriculum is still not fathomed in medical education.