Switching Vancomycin Monitoring From Trough Concentration to Area Under the Curve Estimation by Bayesian Forecasting: A Short Communication on a Cost-Benefit Study in Resource-Limited Settings.

BACKGROUND: This study was conducted to evaluate the cost-benefit indicators of a vancomycin monitoring protocol based on area under the curve estimation using commercial Bayesian software. METHODS: This quasi-experimental study included patients who were aged >18 years with a vancomycin prescription for >24 hours. Patients who were terminally ill or those with acute kidney injury (AKI) ≤24 hours were excluded. During the preintervention period, doses were adjusted based on the trough concentration target of 15-20 mg/L, whereas the postintervention period target was 400-500 mg × h/L for the area under the curve. The medical team was responsible for deciding to stop the antimicrobial prescription without influence from the therapeutic drug monitoring team. The main outcomes were the incidence of AKI and length of stay. Cost-benefit simulation was performed after statistical analysis. RESULTS: There were 96 patients in the preintervention group and 110 in the postintervention group. The AKI rate decreased from 20% (n = 19) to 6% (n = 6; P = 0.003), whereas the number of vancomycin serum samples decreased from 5 (interquartile range: 2-7) to 2 (interquartile range: 1-3) examinations per patient (P < 0.001). The mean length of hospital stay for patients was 26.19 days after vancomycin prescription, compared with 17.13 days for those without AKI (P = 0.003). At our institution, the decrease in AKI rate and reduced length of stay boosted yearly savings of up to US$ 369,000 for 300 patients receiving vancomycin therapy. CONCLUSIONS: Even in resource-limited settings, a commercial Bayesian forecasting-based protocol for vancomycin is important for determining cost-benefit outcomes.

Tradução e Adaptação Transcultural do Instructional Materials Motivation Survey (IMMS) para o Português do Brasil / Translation and Transcultural Adaptation of the Instructional Materials Motivation Survey (IMMS) to Brazilian Portuguese

Resumo: Introdução: No cenário educacional, diversas metodologias de ensino-aprendizagem vêm sendo utilizadas como ferramentas instrucionais, com o objetivo de aumentar a motivação dos estudantes e favorecer a aprendizagem significativa. Por sua vez, instrumentos que avaliem a motivação, após exposição a diferentes estratégias e materiais de ensino, podem contribuir para análise e decisão sobre sua efetividade. Nesse sentido, o questionário Instructional Materials Motivation Survey (IMMS) avalia a motivação, após atividades instrucionais, por meio de quatro domínios: atenção, relevância, confiança e satisfação. Assim, esta pesquisa teve como objetivo realizar a tradução e adaptação transcultural do IMMS para o português brasileiro. Método: A tradução e adaptação transcultural foram realizadas em seis etapas: tradução do questionário original, síntese das traduções, retrotradução, revisão pelo comitê de especialistas, teste da versão pré-final, confecção da versão final e auditoria pelo comitê externo. As traduções foram realizadas por duas professoras de inglês, de língua nativa brasileira. As retrotraduções foram realizadas por dois professores de inglês, de língua nativa inglesa. O comitê de especialistas foi formado por um professor de medicina e educação médica, dois professores de medicina, uma pedagoga, um estatístico e um professor de inglês. A versão brasileira final do IMMS foi testada, após aula invertida, tendo como objetivo avaliar a consistência interna do instrumento. Considerou-se como aceitável valor de alfa de Cronbach ≥ 0,70. Resultados: No processo de tradução e adaptação transcultural, foram atingidas todas as equivalências: semântica, idiomática, cultural e conceitual. Na avaliação da consistência interna, dos 52 estudantes submetidos à aula invertida, 48 (92,3%) responderam à versão brasileira do IMMS. O instrumento apresentou consistência interna de 0,718, avaliada por meio do teste alfa de Cronbach. Conclusões: A versão final do instrumento IMMS, após processo de tradução e adaptação transcultural, manteve todas as suas 36 sentenças e as instruções do instrumento original, e apresenta boa consistência interna, de acordo com o teste alfa de Cronbach. A possibilidade de avaliação da motivação, no contexto educacional, por instrumento amplamente validado, traz consigo ganhos tanto no campo da prática quanto da pesquisa pedagógica. Seu emprego no Brasil possibilitará novas validações em cenários educacionais nacionais e contextos diversos.

Abstract: Introduction: Several educational methodologies have been used as instructional tools, with the objective of increasing student motivation and promoting meaningful learning. In turn, instruments designed to assess a student's motivation after being exposed to different teaching strategies and materials can play an important role in reviewing the effectiveness of such methods. In this sense, the Instructional Materials Motivation Survey (IMMS) evaluates student motivation after instructional activities, through four domains: attention, relevance, confidence and satisfaction. This research aimed to perform the translation and cross-cultural adaptation of the IMMS into Brazilian Portuguese. Method: The cross-cultural translation and adaptation was performed in six stages: translation of the original questionnaire; synthesis of translations; back-translation; review by the Committee of Experts; testing of the pre-final version, preparation of the final version and review by the External Committee. The translations were performed by two English teachers, native Brazilian. The back-translations were performed by two English teachers, native English language. The expert committee was formed by a professor of medicine and medical education, two medical professors, a pedagogue, a statistician and an English teacher. The final Brazilian version of the IMMS was tested following a flipped classroom activity aimed at evaluating the internal consistency of the instrument. A Cronbach alpha value of ≥ 0.70 was considered acceptable. Results: In the process of translation and cross-cultural adaptation, all equivalences were achieved: semantic, idiomatic, cultural and conceptual. In the evaluation of internal consistency, of the 52 students submitted to the flipped classroom, 48 (92.3%) correctly answered the Brazilian version of the IMMS. The instrument presented an internal consistency of 0.718, evaluated using the Cronbach alpha test. Conclusions: The final version of the IMMS instrument, after cross-cultural translation and adaptation, maintained all its 36 sentences and the 3 instructions of the original instrument and presented good internal consistency according to the Cronbach alpha test. The possibility of evaluating motivation in the educational context by means of a broadly validated instrument, brings with it gains both in the field of practice and pedagogical research. Use of the IMMS in Brazil will support new validations in national educational settings and diverse contexts.