Assessment of the impact of e-learning of theoretical anesthesiology for medical students / Avaliação do impacto de ensino teórico de anestesiologia à distância para estudantes de medicina

Abstract: Introduction: Due to the high contamination rate and number of cases of the SARS-Cov-2, local authorities decreed the closure of universities and schools, which has forced these institutions to come up with innovative solutions for the continuation of their activities. Objective: The aim of this study is to assess both the impact and level of satisfaction amongst undergraduate students of the online teaching of theoretical anesthesiology as an alternative method to the face-to-face teaching as the latter is currently impaired by the difficulties imposed by the pandemic. Methodology: The teaching method chosen consisted of conducting online classes taught by a specialist using the Microsoft Teams platform. The level of knowledge of the participants was assessed through the application of questionnaires before and after each term of the course. Results: A total of 812 questionnaires were completed, with a significant increase of 41.61% in the average of correct answers (3.94 vs 5.57; p <0.001). Conclusion: The main focus of this study is that the e-learning of theoretical anesthesiology and its results showed considerable increase in the students' knowledge. Also, it was observed that the levels of satisfaction were higher than the expectation levels.

Resumo: Introdução: Devido à alta taxa de contaminação do SARS-Cov-2 e ao surgimento de um grande número de casos, autoridades locais decretaram o fechamento de universidades e escolas, demandando a implementação de soluções inovadoras para a continuidade das atividades acadêmicas. Objetivo: O objetivo do presente estudo é avaliar o impacto e nível de satisfação do modelo de ensino teórico à distância de anestesiologia em alunos de graduação como método alternativo ao ensino presencial em virtude das dificuldades impostas pela pandemia. Metodologia: O método utilizado consistiu na realização de aulas online ministradas por professor especialista através da plataforma Microsoft Teams. O nível de conhecimento dos participantes foi avaliado por meio da aplicação de questionários antes e após cada módulo do curso. Resultados: Um total de 812 questionários foram preenchidos, tendo sido constatado um aumento significativo de 41,61% na média de acertos geral (3,94 vs 5,57; p < 0,001). Conclusão: O presente estudo trouxe o ensino teórico em anestesiologia à distância como foco principal e os seus resultados mostraram ganho de conhecimento considerável por parte dos participantes. Além disso, foram observados maiores níveis de satisfação em detrimento dos de expectativa.

Screening for neuropathic pain in patients with sickle cell disease: is a single assessment scale sufficient?

BACKGROUND: The objectives of this study were to delineate the clinical-epidemiological profile of patients with neuropathic pain (NP) in the groups of SCD patients, from each of the three questionnaires used DN-4, painDETECT - PDQ, LANSS and to compare these three questionnaires in NP evaluation in SCD carriers. This cross-sectional study evaluated 83 patients with symptomatic SCD, aged 14 years or older. Clinical and laboratory data were extracted from the patients' charts and from information obtained from the patients during the interview before the application of the questionnaire. The calculations were performed using the statistical software Epi InfoTM 7. Pearson's correlation coefficient was used to compare the neuropathic pain evaluation scales with the software BioEstat 5.3. RESULTS: The use of two or more questionnaires may increase the suspicion of NP in patients with SCD and, with a confirmed diagnosis, adequate treatments will benefit patients.

Neuropathic pain in patients with sickle cell disease: a cross-sectional study assessing teens and young adults.

Chronic pain conditions are little studied and may be underestimated in sickle cell disease (SCD). The aim of this study was to identify the occurrence and characteristics of neuropathic pain (NP) in SCD patients. A sample of 56 patients was chosen from a total of 554 patients submitted to the inclusion criteria between 2015 and 2016. The Leeds assessment of neuropathic symptoms and signs scale was used for detecting NP. The groups with and without NP were compared by sex, age, use of hydroxyurea, and sensory changes through Chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis tests. The average age was 20.6 years (SD ± 4.6), 51.8% of the patients were male, and 14 patients (25%) suffered from NP. Most commonly, the pain was reported to be in the lower back area (53.6%). Age was positively related to NP: the average age in the group with NP was 22.7 years (SD ± 4.1) and in the group without NP was 19.8 years (SD ± 4.5), p < 0.05. Higher rates of NP occurred in patients aged 19 years or older, compared with that in teens (p < 0.01). There was a positive association between NP and the use of hydroxyurea (p < 0.05). An association was found between NP and sensitive neurological changes (p < 0.01). Therefore, screening for NP may result in faster and more effective diagnoses and consequently initiate appropriate treatment.

Environmental enrichment for adult rats: effects on trait and state anxiety.

Experimental evidence indicates that enriched environment (EE) induces neurobiological and behavioural alterations. EE in early life improves learning and memory and reduces trait and state anxiety. However, the effect of EE established in adulthood has rarely been investigated. Thus, the aim of this study was to evaluate the possibility of modifying the levels of trait and/or state anxiety of adult rats exposed to EE. Seventy adult Wistar male rats were first tested in the free-exploratory paradigm (FEP) and were categorized according to their levels of trait anxiety (high, medium and low). Subsequently, half of the animals from each category returned to their home cages (standard condition: SC) and the other half was transferred to an enriched environment (enriched condition: EC). After three weeks, all animals were again tested in FEP. Seven to 10 days later, fifty of the seventy animals were tested on the elevated plus-maze test (EPM). In FEP, EE reduced locomotor activity in the second exposition independently of the anxiety category and, it decreased the levels of trait anxiety of highly anxious rats. No effect of EE was observed on EPM. In conclusion, EE established in adulthood was able to reduce high trait anxiety, a major risk factor for anxiety disorders.

Effect of sweet orange aroma on experimental anxiety in humans.

OBJECTIVES: The objective of this study was to evaluate the potential anxiolytic effect of sweet orange (Citrus sinensis) aroma in healthy volunteers submitted to an anxiogenic situation. DESIGN: Forty (40) male volunteers were allocated to five different groups for the inhalation of sweet orange essential oil (test aroma: 2.5, 5, or 10 drops), tea tree essential oil (control aroma: 2.5 drops), or water (nonaromatic control: 2.5 drops). Immediately after inhalation, each volunteer was submitted to a model of anxiety, the video-monitored version of the Stroop Color-Word Test (SCWT). OUTCOME MEASURES: Psychologic parameters (state-anxiety, subjective tension, tranquilization, and sedation) and physiologic parameters (heart rate and gastrocnemius electromyogram) were evaluated before the inhalation period and before, during, and after the SCWT. RESULTS: Unlike the control groups, the individuals exposed to the test aroma (2.5 and 10 drops) presented a lack of significant alterations (p>0.05) in state-anxiety, subjective tension and tranquillity levels throughout the anxiogenic situation, revealing an anxiolytic activity of sweet orange essential oil. Physiologic alterations along the test were not prevented in any treatment group, as has previously been observed for diazepam. CONCLUSIONS: Although more studies are needed to find out the clinical relevance of aromatherapy for anxiety disorders, the present results indicate an acute anxiolytic activity of sweet orange aroma, giving some scientific support to its use as a tranquilizer by aromatherapists.

Automation of the free-exploratory paradigm.

The free-exploratory paradigm (FEP) is currently the only proposed animal model of trait anxiety, making it highly valuable to behavioural neuroscience. However, FEP has not yet been automated, so its results depend on human scoring, which can be quite imprecise. The aim of this study was, therefore, to validate an automated version of FEP, using a commercially available video-tracking system (ANY-maze(©) - Stoelting Co., USA). To achieve this, two experiments were performed. The first one evaluated the reliability of the video-based automation of FEP, and the second, assessed whether the zeolites, used as a bedding material in the first experiment to facilitate video-tracking, influenced the animals' behaviour in FEP. In experiment I, 15 drug-naive, adult, male rats were tested in FEP, while their behaviour was simultaneously evaluated by ANY-maze(©) and two human observers. Subsequently, the intraclass correlation coefficient (ICC) was calculated for the automated and manual results of the parameters "percentage of time in the novel side" (%TNS) and "total units visited" (TUV). The analysis resulted in high, significant values of ICC (%TNS: 0.9962 and TUV: 0.9453). In experiment II, 18 drug-naive, adult, male rats were allocated to two different groups: (1) tested in FEP with zeolites; and (2) tested in FEP with sawdust. The data obtained were analysed using the Student's t-test, which revealed no significant differences between the groups for the parameters %TNS and TUV. In conclusion, the data presented here show that automation of FEP, using a video-based tracking system, is not only possible, but also highly reliable.

Trait and state anxiety in animal models: Is there correlation?

It is believed that subjects with high trait anxiety levels tend to present state anxiety reactions with greater intensity than individuals with low trait anxiety levels. In order to verify if this premise is valid for animal models of anxiety, the present work investigated the possible correlation between two behavioral tests: the elevated plus-maze, a classic model of state-anxiety, and the free-exploratory paradigm, which has been proposed as a model of trait anxiety. The behavior of 46 drug-naive, adult, Wistar, male rats was measured in these two models on two occasions, 1 week apart. Subsequently, the intraclass correlation coefficient (ICC) was calculated for the parameters "percentage of time in the novel side" (%TNS; free-exploratory paradigm), "percentage of time in the open arms" (%TOA; elevated plus-maze) and "percentage of entries into the open arms" (%EOA; elevated plus-maze). These parameters were also used to classify the animals into groups presenting high, medium or low levels of anxiety in both tests, so that the concordance between the models could be evaluated through the kappa test. The analysis resulted in low ICC (%TNSx%TOA: -0.127; %TNSx%EOA: 0.040) and low kappa index (%TNSx%TOA: -0.017; %TNSx%EOA: -0.044), suggesting a poor correspondence between the free-exploratory paradigm and the elevated plus-maze. In conclusion, the data presented here indicate that the premise of correlation between trait and state anxiety is not necessarily true for animal models of anxiety and, therefore, care must be exercised when using state anxiety models in order to determine animals' anxiety profile.