Content and Usability Validation of an Intelligent Virtual Conversation Assistant Used for Virtual Triage During the COVID-19 Pandemic in Brazil.

This study aimed to describe the development process, content validation, and usability of a COVID-19 screening system incorporated into a chatbot-type intelligent virtual assistant (CoronaBot). This is a methodological research carried out in three phases. The first corresponded to the development of the flowchart and content of the virtual assistant, the second phase consisted of the implementation of the content in chatbot, and the third phase consisted of content validation. Data analysis was performed by agreement rate, content validity index, and kappa statistical test. Finally, in the third phase, the chatbot's usability was analyzed using the System Usability Scale, by 10 users. The CoronaBot content presented domains with agreement rate above 87.5%, and its items referring to symptomatological scores and interface screens had values of content validity index with a mean of 0.96, kappa test with values from 0.70 to 0.76, and interspecialist agreement of 1.00, demonstrating excellence of prototype content. The global usability score was 80.1. The script developed and incorporated into the chatbot prototype achieved a satisfactory level of content validity. The usability of the chatbot was considered good, adding to the credibility of the device.

Early liver function improvement following successful treatment of chronic hepatitis C in patients with decompensated cirrhosis: a real-life study.

OBJECTIVES: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil. METHODS: We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil. RESULTS: Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir±ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p=0.001; OR:39.285; 95% CI:4.301-258.832). CONCLUSIONS: Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.

Content validation and usability of a chatbot of guidelines for wound dressing.

INTRODUCTION: The growing demand from patients with wounds from various causes has significantly challenged primary care nurses. A chatbot, with duly validated evidence-based content, can assist both nurses and patients in managing care. This work describes the development process of such a chatbot (BOTCURATIVO) that aims to help the treatment of wounds by non-specialists, by giving guidelines about the recommended wound dressing procedures for each type of wound. METHOD: Methodological research was carried out in three phases. The first one corresponded to the validation of the script's content through a panel of enterostomal therapist nurses, who evaluated the domains and items of the chatbot script. Data analysis was performed using the Content Validity Index by individual level and scale level (≥ 0.80). To verify the agreement between the evaluators, the Kappa test was used. In the second phase, the chatbot was developed, using GOOGLE'S DIALOGFLOW platform. Finally, in the third phase, the chatbot's usability was analyzed using the System Usability Scale (SUS), by 17 users, 8 of them being patients with chronic wounds, 5 caregivers of people with acute and chronic wounds and 4 nurses. RESULTS: The established domains achieved excellent suitability, relevance and representativeness criteria, all above 90 %; the content validity index per level of scale reached 0.97 and 0.82 by the methods of average and universal agreement, respectively, with excellent agreement between the evaluators (Kappa value: 0.83). The global usability score was 80.1. CONCLUSION: The script developed and incorporated into the chatbot prototype achieved a satisfactory level of content validity. The usability of the chatbot was considered good, adding to the credibility of the device.

Early liver function improvement following successful treatment of chronic hepatitis C in patients with decompensated cirrhosis: a real-life study

OBJECTIVES: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil. METHODS: We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil. RESULTS: Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir±ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p=0.001; OR:39.285; 95% CI:4.301-258.832). CONCLUSIONS: Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.

Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient.

A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura (ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack of tuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.

Exercício Profissional da Medicina por Estudantes / Professional Practice of Medicine by Students

Resumo: As atividades práticas desempenhadas pelo aluno de medicina são indispensáveis e devem ser realizadas em ambiente universitário. Quando este procura outros serviços para exercer a profissão médica, infringe os códigos de ética médica e penal brasileiros. Objetivamos identificar e analisar as atividades profissionais na área médica exercidas pelos estudantes de medicina da Universidade Federal de Uberlândia (UFU) fora desta instituição. Foi aplicado um questionário com 19 perguntas a 173 alunos do 6o a 12o períodos do curso médico da UFU. Verificou-se que 23,70% dos alunos exerceram a profissão médica fora da instituição de ensino. Durante o último ano do curso, 63,16% já o fizeram. A totalidade destes alunos prestou serviços remunerados, a maioria em hospitais públicos (48,78%) e 21,96% os realizam frequentemente. Ademais, 46,34% das atividades foram indicadas por médicos formados, coniventes com tal situação; 31,71% nunca dizem ao paciente que não são médicos formados; 39,03% consideram tais atividades totalmente antiéticas e 68,29% totalmente ilegais, mas mesmos assim continuam a praticá-las. Este dados preocupantes mostram ser imprescindível uma atuação conjunta de professores, CFM e dos próprios alunos com o objetivo de corrigir este grave erro de conduta.

Abstract: The practical activities carried out by medical students are indispensable and should be applied in academical institutions. When these students seek other services to exercise the medical profession, they infringe the penal and the medical ethics codes. We aim to identify and analyze the professional activities in the medical area exercised by the students to medicine of the Federal University of Uberlândia (UFU) out of this institution. A questionnaire was applied to 173 students of the 6th to the 12th periods, of the Medical School of UFU. It was verified that 23,70% of the students exercised the medical profession out of the institution. During the last year of the course, 63,16% have already done it. All the students rendered paid services, inmost in public hospitals (48,78%), and 21,96% frequently accomplish them. Also, 46,34% of the activities were indicated by formed doctors, connivent with such situation; 31,71% never tell the patient that he/she isn't a formed physician; 39,03% consider it totally anti-ethics and 68,29% illegal, but even so they continue to practice them. These preoccupying data show it is indispensable that professors, CFM and students should act with the objective of correcting this misconduct.Introdução