Teaching basic life support for medical students: Assessment of learning and knowledge retention.

BACKGROUND: Education mediated by simulation is a widely used method for teaching basic life support (BLS). The American Heart Association recommends protocols based on scientific evidence to reduce sequelae and mortality. We aimed to assess learning and retention of knowledge of BLS in students of the first semester of the medical course using teaching methods of dialogic expository class (group 1), expository and demonstrative class (group 2), and the two previous methodologies associated with simulated practice (group 3), and after 3 months, memory retention. MATERIALS AND METHODS: This was an experimental, prospective, randomized study. Participants were assessed in terms of performance in theoretical and simulated practical tests, satisfaction with training (Likert scale), and knowledge retention. RESULTS: The practical test results were analyzed by two experienced observers. Students had 20% progression in knowledge and 80% retention of knowledge after 3 months of exposure comparing the theoretical pre- and posttest. The students in group 3 performed better than the others (P = 0.007) in the posttest. With the simulated practice, the knowledge acquired was maintained after 3 months with a mean performance of 90%, but in the test of the infant age group, there was a loss of learning retention by 10%. There was no difference of the results between the two evaluators (P < 0.001). The training was positively assessed by the participants. CONCLUSION: The use of different methodologies promoted knowledge progression, with emphasis on simulated practice. Learning retention was maintained after 3 months. In order to teach BLS to infants, it may be necessary to improve teaching techniques.

COVID-19: Distance learning to empower educators and health assistants in rural areas.

BACKGROUND: Educators and health assistants can act as key players in controlling the pandemic. In general, they are respected by the community, especially in rural areas, and can help guide and raise the population's awareness of preventive measures. The objective of this paper is to evaluate the results in knowledge progress of an e-learning course offered to educators and health assistants by a public university and to analyze the profile and satisfaction of the participants. MATERIALS AND METHODS: A single group pre- and post-test design based on a questionnaire, interventional, study was conducted in the period from April 20th to June 20th. All participants of the course answered sociodemographic and satisfaction questionnaire and a pre- and post-test. Data were descriptively arranged and regarding the distribution and comparison of means and frequency, paired t-test for group comparisons. P < 0.05 was statistically significant. Data were collected from the Moodle® teaching platform, without identifying the participants. RESULTS: A total of 674 participants were enrolled in the five groups, and 583 concluded the course (86.5%). The reasons for those who did not access the entire course (n = 47) were: Lack of time, difficulty in accessing the internet, and lack of experience with distance learning courses. On the evaluation of the course platform, from the tutors in general and the degree of satisfaction in several questions, participants marked maximum grades. The comparison between pre- and post-proficiency scores showed increased proficiency of the enrolled groups (P < 0.0001). CONCLUSIONS: The course contributed to the training of health assistants and educators, preparing them to act in a participatory way in the prevention and control of the pandemic. The course was well evaluated and there was a progression of knowledge by the participants.

Teamwork in Pediatric Resuscitation: Training Medical Students on High-Fidelity Simulation.

Background: Simulation training and teamwork for medical students are essential to improve performance in pediatric cardiopulmonary resuscitation. Purpose: To evaluate if a specific approach to teamwork improves technical and nontechnical performance. Methods: We performed quasiexperimental, prospective, pre- and postinterventional, and nonrandomized research with 65 students in the fourth year of their medicine course. This was a case-control study in which teams used a customized TeamSTEPPS protocol (n=34) or not (n=31) for cardiopulmonary arrest training in children using high-fidelity simulation. All participants answered a sociodemographic and satisfaction questionnaire and underwent theory and practice pre- and posttesting. The survey data were collected in 2019 and analyzed using χ2, Mann-Whitney, κ, and Wilcoxon tests. p<0.05 was considered significant. Results: Intervention and control groups achieved better scores in theory posttesting (p<0.001 and p=0.049), but there was no difference between them in pre- (p=0.291) and posttesting (p=0.397). In the checklist of the practice test, all groups obtained their best outcomes in posttesting and the intervention group achieved higher scores (p<0.001). All groups increased the number of teamwork events and reduced the time span to perform resuscitation first steps (p<0.001) in posttesting. Conclusion: The use of teamwork training based on a customized TeamSTEPPS protocol improved performance in team behavior and group technical achievement. The evaluation of the students about the training was positive.

Belo Horizonte Telehealth: Incorporation of Teleconsultations in a Health Primary Care System.

INTRODUCTION: The Belo Horizonte Telehealth program, a pioneer in telemedicine within the Brazilian National Health System (Sistema Único de Sauùde in Portuguese), was implemented by the Belo Horizonte City Health Department (SMSA-BH) in 2004. The purpose of the present study is to analyze opinions on the obstacles, difficulties, and suggestions on the use of teleconsultations. METHODS: Semi-structured interviews were conducted among primary healthcare professionals and health managers. Content analysis for the latter was carried out using NVIVO® software to categorize responses. Simple descriptive quantitative aspects were analyzed to verify the use of the system over the years by the primary care unit (PCU) professionals. RESULTS: The difficulties encountered were related to the use of the system, inadequate response to teleconsultation requests, infrastructure problems, lack of practicality for the use of the program, difficulty in incorporating the program into the organizational culture, and lack of managerial support. Changes in management organization over the years have interfered with the use of the teleconsultation system. The most requested specialties were neurology, cardiology, endocrinology, and angiology. DISCUSSION: The main suggestions for increasing the number of teleconsultations requests included dissemination of information and prioritization by the management; improvement of the infrastructure; organization of the time and the agenda of the PCU professional; training the professionals for its use; and preconditioning the referrals to secondary level care to a previous teleconsultation. CONCLUSION: Teleconsultations need to be incorporated in the daily routine of PCUs by both managers and health professionals to assure its usage and improve the quality of care.

Teleconsultations in public primary care units of the city of belo horizonte, Brazil: profile of patients and physicians.

OBJECTIVE: The aim of this study is to report patient and physician profiles of those who used the teleconsultation system in the primary care health units of a health district in the city of Belo Horizonte, MG, Brazil. MATERIALS AND METHODS: Data were collected from the telehealth attendance records of nine Primary Health Units (Unidade Básica de Saúde [UBS] in Portuguese) and from interviews carried out with the referring physicians. The criteria for inclusion required that data come from users seen by means of telehealth in the period between December 2004 and August 2010 and from the practitioners who saw them. The following were excluded: physicians who were not working in the UBS when the data were collected and a physician who did not agree to take part in the study. RESULTS: Two hundred sixty-three teleconsultations were analyzed, and 20 referring physicians were interviewed. The offline method was the most common. The physicians were predominantly female and had graduated over 11 years ago. The patients were predominantly adult women. After teleconsultation, a prescription was not necessary for 9.8% of patients. When required, 83.2% of the medication was available in the UBS. In 68.3% of cases, additional tests were required. The incorporation of these technologies prevented the physical referral of patients in 64.2% of cases. CONCLUSIONS: Telehealth resources can help to improve the provision of primary healthcare, reducing the number of physically referred patients. The number of teleconsultations is still small, and there is a need to encourage physicians to use the system.

Evaluation of the presence of hereditary and acquired thrombophilias in Brazilian children and adolescents with diagnoses of portal vein thrombosis.

OBJECTIVE: The aim of this study was to describe the prevalence of main hereditary thrombophilias, Janus kinase 2 (JAK2) V617F mutation, antiphospholipid antibody syndrome (APS), and hyperhomocysteinemia in Brazilian children and adolescents diagnosed with portal vein thrombosis (PVT) without associated hepatic disease. METHODS: A cross-sectional study was carried out with 32 children with PVT in accompaniment at Hospital das Clínicas of the Universidade Federal de Minas Gerais from January 1990 to July 2011. Laboratory evaluation of thrombophilias was performed from September 2010 to July 2011. RESULTS: Thirty-two patients were evaluated; 59% were boys. Median age at diagnosis was 2.4 years. Mean time of patients' accompaniment was between 4.7 and 5.2 years. The presence of hereditary and acquired thrombophilias occurred in 34.4% of patients, and 9 of them also showed other risk factors in the previous history evaluation. Risk factors were absent in the previous history of 18 patients (56.3%). Two patients showed persistent high titres of anticardiolipin antibodies. Hyperhomocysteinemia was not observed. One patient was heterozygous for factor V Leiden and prothrombin G20210A mutation (3.1%). Eleven patients (34.4%) showed heterozygous methylenetetrahydrofolate reductase (MTHFR) C677T, and no patient had the JAK2V617F mutation. CONCLUSIONS: Even after investigation of main hereditary and acquired thrombophilia, PVT remains without apparent cause in most patients. Nevertheless, association of local and systemic risk factors seems to be important also in the pediatric age group. Therefore, despite the low prevalence, a complete investigation, which includes both hereditary and acquired thrombophilias, may be necessary.

Evaluating the experience of training through videoconferences in primary care.

INTRODUCTION: The technological innovations that are a part of organizational realities allow for new possibilities in social processes. In Belo Horizonte, Brazil, the municipality established a system of training through videoconferences in primary care connecting professors and professionals from primary care units to discuss assistance problems in medicine, nursing, and dentistry. OBJECTIVE: An evaluation of the professionals' perception regarding the system of training through videoconferences in primary care. METHODS: The study involved 148 basic health units in the city of Belo Horizonte. A structured survey was applied to a sample of 373 people who used the system in 2008. RESULTS: According to the survey data, 58.6% of the professionals participated in more than three videoconferences in 6 months, whereas 30.3% did not participate in any type of face-to-face training activity; 98% considered the topics interesting and 70% affirmed that the topics discussed helped them when performing assistance tasks. Other aspects that were evaluated as excellent or good include: 36.6% approved the sound quality of the videoconferences, 46.4% approved the image quality, and 43.9% approved the system stability. These results highlight some problems. Nevertheless, 90.2% evaluated the telehealth project as being excellent or good and 96.7% would recommend the implementation of the project in other units. CONCLUSIONS: The system of educational training videoconferences can contribute to improving the competence of primary healthcare attention.

Telehealth in primary healthcare: an analysis of Belo Horizonte's experience.

BACKGROUND: Telehealth resources were implemented in the city of Belo Horizonte, providing tools for the medical assistance model as well as strengthening the quality of primary healthcare attention. OBJECTIVE: The objective of this study was to analyze the characteristics of the incorporation of telehealth resources in Belo Horizonte, Brazil, and its contribution to the structuring of primary healthcare. MATERIALS AND METHODS: This study focused on a description of the telehealth projects related to primary healthcare in the city and the results of the implementation process. The sources for this analysis include documents presented to financing institutions, reports from the Belo Horizonte City Department of Health, and articles and technical reports related to the evaluations of the project. RESULTS: The BHTelehealth Project has been established in 148 basic health units in Belo Horizonte. It develops assistance and educational activities by using 3D modeling, interactive videos, and animations. The analysis of this implementation process identified both positive and negative aspects. Telehealth has strengthened the role of primary healthcare as the coordinator of attention. It has reinforced primary care units by widening the scope of attention offered at this level and has provided primary care staff with a powerful arsenal of up-to-date information and tools. CONCLUSION: BHTelehealth served as a model for implementing the National Telehealth Program, in course in Brazil, involving 900 cities. This is attributed to its positive impact on the training of primary care unit professionals.