Postcolonoscopy Diverticulitis.

Colonoscopy, generally safe but not devoid of risks, can lead to rare complications. We present 2 cases of postcolonoscopy diverticulitis (PCD). Case 1 was a 63-year-old woman, following colonoscopy, who developed acute sigmoid diverticulitis, despite a Diverticular Inflammation and Complication Assessment (DICA) score of 2, indicating extensive diverticulosis without inflammation. Conservative management with antibiotics led to recovery. Remarkably, she experienced a recurrent episode. Case 2 was a 74-year-old woman who had 2 colonoscopies, revealing pancolonic diverticulosis (DICA score: 2) without inflammation. After the second procedure, she developed severe sigmoid diverticulitis, managed conservatively with antibiotics. Discussion highlights PCD's rarity (prevalence: 0.04%-0.08%) and unclear pathogenesis. Both cases had DICA scores ≥2, suggesting a potential risk factor. Clinicians should recognize PCD, as it can mimic more common postcolonoscopy complications. Early recognition and management are vital.

Diverticular Inflammation and Complication Assessment classification, CODA score and fecal calprotectin in clinical assessment of patients with diverticular disease: A decision curve analysis.

BACKGROUND AND AIMS: The Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) were found to be effective in predicting the outcomes of Diverticular Disease (DD). We ascertain whether fecal calprotectin (FC) can further aid in improving risk stratification. METHODS: A three-year international, multicentre, prospective cohort study was conducted involving 43 Gastroenterology and Endoscopy centres. Survival methods for censored observations were used to estimate the risk of acute diverticulitis (AD) in newly diagnosed DD patients according to basal FC, DICA, and CODA. The net benefit of management strategies based on DICA, CODA and FC in addition to CODA was assessed with decision curve analysis, which incorporates the harms and benefits of using a prognostic model for clinical decisions. RESULTS: At the first diagnosis of diverticulosis/DD, 871 participants underwent FC measurement. FC was associated with the risk of AD at 3 years (HR per each base 10 logarithm increase: 3.29; 95% confidence interval, 2.13-5.10) and showed moderate discrimination (c-statistic: 0.685; 0.614-0.756). DICA and CODA were more accurate predictors of AD than FC. However, FC showed high discrimination capacity to predict AD at 3 months, which was not maintained at longer follow-up times. The decision curve analysis comparing the combination of FC and CODA with CODA alone did not clearly indicate a larger net benefit of one strategy over the other. CONCLUSIONS: FC measurement could be used as a complementary tool to assess the immediate risk of AD. In all other cases, treatment strategies based on the CODA score alone should be recommended.

When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach.

Colonoscopy is a crucial diagnostic tool in managing diverticular disease (DD). Diverticulosis can often be an unexpected diagnosis when colonoscopy is performed in asymptomatic subjects, generally for colorectal cancer screening, or it could reveal an endoscopic picture compatible with DD, including acute diverticulitis, in patients suffering from abdominal pain or rectal bleeding. However, alongside its role in the differential diagnosis of colonic diseases, particularly with colon cancer after an episode of acute diverticulitis or segmental colitis associated with diverticulosis, the most promising use of colonoscopy in patients with DD is represented by its prognostic role when the DICA (Diverticular Inflammation and Complication Assessment) classification is applied. Finally, colonoscopy plays a crucial role in managing diverticular bleeding, and it could sometimes be used to resolve other complications, particularly as a bridge to surgery. This article aims to summarize "when" to safely perform a colonoscopy in the different DD settings and "why".

KPSI como herramienta de autoevaluación metacognitiva en el desarrollo de la competencia intercultural en salud en medicina / KPSI as a metacognitive self- assessment tool in the development of intercultural health competence in medicine

La autoevaluación es necesaria para el aprendizaje efectivo, mejorar la autoeficacia, y el desempeño académico. Dentro de los instrumentos de autoevaluación existe el Knowledge and Prior Study Inventory (KPSI) con cualidades metacognitivas. El objetivo de este trabajo fue examinar los resultados de la aplicación de KPSI en un curso de Interculturalidad y Salud y recoger la percepción de estudiantes respecto a su uso en medicina. Este fue un trabajo de naturaleza mixta. La etapa cuantitativa evaluó los puntajes del instrumento autoaplicado al inicio y al final de la asignatura, arrojando el delta promedio del curso. La etapa cualitativa exploró las percepciones del uso y utilidad en el aprendizaje del instrumento. Se realizaron dos grupos focales, se transcribieron los audios siguiendo el principio de verbatim. Se realizó análisis de contenido. La participación voluntaria y anónima. El puntaje promedio del test al inicio del curso fue de 1,7 puntos elevándose a 3,6 durante la segunda aplicación. Las preguntas con menor puntaje diferencial consideran contenidos integrados en asignaturas previas al curso, mientras que las preguntas con mayor puntaje diferencial estaban integradas por contenidos de aporte exclusivo de la asignatura. Los resultados cualitativos son claramente positivos en la percepción de aprendizaje, ayuda a identificar las fortalezas y debilidades individuales durante el proceso de aprender. Por otro lado, los invita a hacer evidente la metacognición, vale decir, cuestionarse el propio proceso de aprendizaje y lo difícil que son los procesos evaluativos en general. Las autoevaluaciones formativas con enfoque metacognitivo son positivas para el aprendizaje y se recomienda su incorporación en carreras de la salud. Es fundamental para el trabajo en el sistema de salud con la diversidad cultural de Chile que médicos desarrollen la competencia intercultural propiciada a través de la metacognición.

Self-assessment is necessary for effective learning, self-efficacy improvement, and academic performance. Among the self-assessment instruments, there is the Knowledge and Prior Study Inventory (KPSI) with metacognitive attributes. This work aimed to examine the results from the KPSI application in an Interculturality and Health course and to collect the students perception regarding its use in medicine. This was mixed nature work. The quantitative stage assessed the scores from the instrument self-administered at the beginning and the end of the course, giving the average delta of the course. The qualitative stage explored the use and utility perception in instrument learning. Two focal groups were made, the audios were transcribed following the verbatim principle. A content analysis was performed. Participation was voluntary and anonymous. The test average score at the beginning of the course was 1.7 increasing to 3.6 during the second application. The questions with fewer differential scores consider integrated contents in subjects before the course, while the questions with greater differential scores were integrated by the content of the exclusive contribution of the subject. The qualitative results were positive in the learning perception, assists to identify the individual strengths and weaknesses during the learning process. On the other side, they are invited to make clear the metacognition, meaning, question the own learning process, and the difficulty of the assessment process in general. The formative self-assess with metacognitive focus is positive for learning and their addition is recommended for health careers. It is key for the work in the health system with cultural diversity from Chile that clinicians develop the intercultural competence promoted by metacognition.

A recuperação da memória operacional visual não é afetada por flicker cromático / The retrieval from visual working memory is not affected by chromatic flicker / La recuperación de la memoria operativa visual no es afectada por el flicker cromático

Nós investigamos o efeito da informação visual irrelevante (IVI) na recuperação da informação na memória de trabalho. Os participantes realizaram uma tarefa de reconhecimento visual. Em metade das provas, uma dica retroativa espacial foi apresentada no intervalo de retenção. A IVI, um flicker cromático, com frequências de 1,0 Hz, 7,3 Hz e 15,3 Hz, foi apresentada no intervalo entre dica e teste. A dica melhorou a acurácia e a rapidez na tarefa de reconhecimento. O flicker não afetou o desempenho. A dica retroativa pode permitir a recuperação da informação para um estado ativo e pode tê-la protegido da interferência do flicker.

We investigated the effect of irrelevant visual information (IVI) on retrieving information from working memory. Participants performed a visual recognition task. In half of the trials, a retroactive spatial cue was presented in the retention interval. The IVI, a chromatic flicker, with frequencies of 1.0 Hz, 7.3 Hz, and 15.3 Hz, was presented in the interval between cue and test. The cue improved the accuracy and speed of the recognition task. The flicker did not affect performance. The retroactive cue may allow the retrieval of information to an active state and may have protected it from the flicker interference.

Nosotros investigamos el efecto de la información visual irrelevante (IVI) en la recuperación de información de la memoria operativa. Los participantes realizaron una tarea de reconocimiento visual. En mitad de las pruebas, se presentó una pista espacial retroactiva en el intervalo de retención. El IVI, un flicker cromático, con frecuencias de 1,0 Hz, 7,3 Hz y 15,3 Hz, se presentó en el intervalo entre pista y prueba. La pista mejoró la precisión y la velocidad de la tarea de reconocimiento. El flicker no afectó el performance. La pista puede permitir la recuperación de la información a un estado activo y puede haberla protegido de la interferencia del flicker.

¿ Es necesario tener conocimientos avanzados de estadística para acceder a las publicaciones módicas? / Is it necessary to have advanced statistical knowledge to access medical literacy?

La introducció;n de análisis estadísticos en revistas biomó;©dicas debe atribuirse a Dunn y a Greewood en la dó;©cada del 30, quienes reflejan los conceptos del análisis e interpretació;n estadística. El objetivo del trabajo fue analizar la utilizació;n de distintas pruebas estadísticas y el grado de accesibilidad análisis-dependiente y artículo-dependiente de los artículos originales publicados en la revista Medicina (B Aires) en el período 2008-2017. Se realizó; un estudio bibliomó;©trico, descriptivo, observacional, de corte transversal, en el cual se incluyeron los artículos originales que fueron evaluados de acuerdo a la escala propuesta por Mora Ripoll y col. Se revisaron 301 artículos en idioma espaó;±ol, el 96% presentó; análisis estadísticos. Entre los 215 artículos que emplearon alguna tó;©cnica de estadística inferencial, el 49.7% utilizó; la prueba chi-cuadrado, pruebas z para proporciones, el test exacto de Fisher o prueba de McNemar. El 29.2% empleó; pruebas t de student y pruebas z, incluyendo el uso de estas tó;©cnicas o de intervalos de confianza para contrastes de conformidad de medianas, y/o homogeneidad de medianas (dos muestras), en muestras apareadas o independientes. Los resultados indican que un lector conocedor de las pruebas incluidas en el Nivel II tendrá acceso estadístico al 75% de los artículos originales publicados. Se comprobó; que no es necesario tener conocimientos avanzados de estadística para acceder a la mayoría de las publicaciones, pero sí es importante que estos contenidos sean desarrollados haciendo hincapí en el razonamiento estadístico por sobre la aplicació;n y utilizació;n de software o la elecció;n del test adecuado.

The introduction of statistical analysis in biomedical journals should be attributed to Dunn and Greenwood in the 1930s, who reflect the concepts of statistical analysis and interpretation. The aim of this study was to analyze the use of different statistical tests and the level of accessibility analysis-dependent and article-dependent of the original articles published in the journal Medicina (B Aires) in the period 2008-2017. A bibliometric, descriptive, observational, cross-sectional study was carried out, in which the original articles were evaluated according to the scale proposed by Mora Ripoll et al. From the 301 articles in Spanish reviewed, 96% presented statistical analyses. Among the 215 articles that used some inferential statistics technique, 49.7% used the chi-square test, z tests for proportions, the Fisher exact test or the McNemar test; 29.2% used student t-tests and z-tests, including the use of these techniques or the use of confidence intervals for medium-conformance contrasts, and /or median-homogeneity (two samples), in paired or independent samples. The results indicate that a reader who knows about the tests included in Level II will have statistical access to 75% of the original articles published. It was found that it is not necessary to have advanced knowledge of statistics to access most publications, but it is important that these contents are developed with emphasis on statistical reasoning over the application and use of software or the choice of the appropriate test.

Utilización de la Escala de Empatía Médica de Jefferson en Residentes que realizan su especialización en un hospital peruano / Use of the Jefferson’s Medical Empathy Scale in Resident physicians in specialization training in a Peruvian hospital

La empatía es definida como la capacidad de comprender los sentimientos y emociones de los demás, basada en el reconocimiento del otro como persona similar o semejante. Aplicada a la relación médico-paciente, puede mejorar los resultados clínicos, por lo que es considerada una habilidad esencial en la capacitación de todo profesional médico. Objetivo: Identificar el nivel de empatía y factores relacionados en médicos residentes de áreas médicas y quirúrgicas realizando entrenamiento especializado en un hospital de Lima, Perú. Material y métodos: Se obtuvieron esenciales datos sociodemográficos y profesionales y se aplicó la Escala de Empatía Médica de Jefferson, conformada por 20 preguntas, con puntuación Likert de 1 a 7, puntaje mínimo de 20 y máximo de 140, y nivel de empatía directamente proporcional al puntaje obtenido. Resultados: Cien médicos residentes, 52% de sexo femenino constituyeron la muestra. La media del puntaje obtenido fue 112,88, con DE 14.51, mediana de 115 y coeficiente alfa de Cronbach de 0,82. Los valores de los cuartiles fueron de 102, 115 y 124. Veintiséis por ciento de los médicos residentes de medicina, 19,2% de cirugía, 10% de Gineco-obstetricia y 35% de pediatría alcanzaron puntajes del cuartil superior. No se hallaron diferencias estadísticamente significativas al comparar el puntaje de los encuestados con cada una de las variables estudiadas. Conclusiones: Los médicos residentes de la especialidad de Pediatría presentaron puntajes más altos que el resto de especialidades, pero no se encontraron variables específicas significativas para explicar las diferencias detectadas en niveles de empatía.

Empathy is defined as the ability to understand the feelings and emotions of others, based on the recognition of the other as similar. Applied to the doctor-patient relationship can improve clinical outcomes, reason for which it is considered an essential ability in the training of every medical professional. Objective: To identify the level of empathy and related factors in resident physicians in medical and surgical specialized training in a hospital in Lima, Peru. Material and methods: Sociodemographic, personal and professional data were obtained and the Jefferson Medical Empathy Scale, consisting of 20 questions and a 1 to 7 Likert scoring type, was applied; with a minimum score of 20 and maximum of 140, the level of empathy is directly related to the obtained score obtained. Results: One hundred resident physicians, 52% of them female, were surveyed. The mean score obtained was 112.88, with DE 14.51, median of 115, and a Cronbach’s alpha coefficient of 0.82. The values of the quartiles were 102, 115 and 124. Twenty-six per cent of medical residents, 19.2% of surgery, 10% of gynecology-obstetrics and 35% of pediatrics reached higher values of the upper quartile. No statistically significant differences were found when comparing the respondents’ scores with each of the identified variables. Conclusions: Residents of the Pediatrics specialty has higher scores than the rest of the specialties, although no specific significant variables were found to explain the differences between the empathy levels.

Textbook Outcome: an Ordered Composite Measure for Quality of Bariatric Surgery.

INTRODUCTION: Textbook outcome (TO) studies have previously shown that a composite measure can provide additional information on the overall quality of surgical care. However, these were binominal outcomes which do not give individual hospitals the required information on how to improve their performance. The aim of this study is to create an ordered TO consisting of multiple outcome parameters for bariatric surgery to assess the extent of hospital variation. METHODS: Patients who underwent a primary bariatric procedure in the Netherlands were included for analyses. The outcomes were ordered as mortality, severe postoperative complications, readmission, mild complications and prolonged length of stay (LOS) within 30 days after primary surgery with TO defined as none of these outcomes occurring. Hospitals were identified with a significantly higher or lower observed/expected ratio than expected based on case-mix and the extent of hospital variation was expressed as the median and interquartile range (IQR). RESULTS: From a total of 27,360 patients on average, 88.7% reached TO (range 35.5-96.9%). Two hospitals had less than expected TO due to more prolonged LOS (57.6%) in one hospital and more mild complications in another (17.1%). Hospital variation was much smaller for TO (median OR 0.91 IQR [0.62-1.06]) than for an ordered TO (median POR 0.66 IQR [0.55-0.96]). CONCLUSION: Using the ordered TO for bariatric surgery, more hospital variation was captured thereby enabling individual hospitals to identify which outcomes and specific groups need improvement. This could attribute to the ongoing effort to improve the quality of the outcome of bariatric surgery.

Perioperative Outcomes of Primary Bariatric Surgery in North-Western Europe: a Pooled Multinational Registry Analysis.

INTRODUCTION: The global prevalence of obesity has increased in recent decades, and bariatric surgery has become a part of the treatment algorithm of obesity. National high-quality registries enable large-scale evaluations of the use and outcome of bariatric surgery and may allow for improved knowledge. The main objective was to evaluate the rate and type of complications after primary bariatric surgery in three North-Western European countries using nationwide registries. MATERIALS AND METHODS: Data from three registries for bariatric surgery were used (January 2015-December 2016). All registries have nationwide coverage with data on patient characteristics, obesity-related diseases, surgical technique, complications, grading of complications, reinterventions, readmissions, and mortality. Eligibility criteria for bariatric surgery were similar and included body mass index of ≥ 40.0 or ≥ 35.0 kg/m2, with one or more obesity-associated diseases. RESULTS: A total of 35,858 procedures (32,177 primary) were registered. The most common procedure was gastric bypass in the Netherlands (78.9%) and Sweden (67.0%), and sleeve gastrectomy in Norway (58.2%). A total of 904 (2.8%) patients developed major complications after primary surgery and 12 patients (0.04%) died within 30 days. Total number of complications between the registries were comparable (p = 0.939). However, significant differences were seen for Clavien-Dindo Classification grades IIIb and IV (p < 0.001). Pooled readmission rates were 4.3% (n = 1386). DISCUSSION: Bariatric surgery is safely performed in the three evaluated countries. Standardization of registries and consensus of variables are essential for international comparison and may contribute to improved quality of treatment across nations.

A Dutch Nationwide Bariatric Quality Registry: DATO.

INTRODUCTION: In the Netherlands, the number of bariatric procedures increased exponentially in the 90s. To ensure and improve the quality of bariatric surgery, the nationwide Dutch Audit for Treatment of Obesity (DATO) was established in 2014. The audit was coordinated by the Dutch Institute for Clinical Auditing (DICA). This article provides a review of the aforementioned process in establishing a nationwide registry in the Netherlands. MATERIALS AND METHODS: In collaboration with the DATO's scientific committee and other stakeholders, an annual list of several external quality indicators was formulated. This list consists of volume, process, and outcome indicators. In addition to the annual external indicators, the database permits individual hospitals to analyze their own data. The dashboard provides several standardized reports and detailed quality indicators, which are updated on a weekly base. RESULTS: Since the start, all 18 Dutch bariatric centers participated in the nationwide audit. A total of 21,941 cases were registered between 2015 and 2016. By 2016, the required variables were registered in 94.3% of all cases. A severe complicated course was seen in 2.87%, and mortality in 0.05% in 2016. The first-year follow-up shows a > 20% TWL in 86.1% of the registered cases. DISCUSSION: The DATO has become rapidly a mature registry. The well-organized structure of the national audit institution DICA and governmental funding were essential. However, most important were the bariatric teams themselves. The authors believe reporting the results from the registry has already contributed to more knowledge and acceptance by other health care providers.

Impact of diverticular inflammation and complication assessment classification on the burden of medical therapies in preventing diverticular disease complications in Italy.

BACKGROUND: Several treatments are currently advised to manage diverticular disease (DD) patients, but their impact on the burden of the disease is unknown. Our aim was to assess the economic analysis of using the recent Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the burden of medical therapies prescribed in preventing DD complications occurrence in Italy. METHODS: We assessed retrospectively the cost/year of treatments in estimated DICA 1, DICA 2 and DICA 3 population. Analysis of diverticulosis prevalence was estimated according to data population provided by Italian Institute of Statistics (ISTAT). Cost of treatments calculated according to data on drugs' consumption collected during the DICA study. RESULTS: We estimated that >8 million of Italian people >60 years may have diverticulosis, and that about 75% of diverticular population are on DICA 1, about 30% on DICA 2, and about 13% on DICA 3. We estimated that >387 million of euros could be spent in DICA 1 population, >203 million of euros in DICA 2 population, and >88 million of euros in DICA 3 population. Since medical treatments did not show any significant advantage when treating DICA 1 and DICA 3 people in terms of prevention of acute diverticulitis occurrence/recurrence and surgery occurrence, we can estimated that >475 million of euros could be spent in Italy without any significant benefit in preventing DD complications occurrence. CONCLUSIONS: DICA endoscopic classification may have a significant impact on the burden of DD in Italy, because it helps to select DD people who effectively need treatments in terms of prevention of acute diverticulitis occurrence/recurrence and surgery occurrence.

Regional brain network organization distinguishes the combined and inattentive subtypes of Attention Deficit Hyperactivity Disorder.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized clinically by hyperactive/impulsive and/or inattentive symptoms which determine diagnostic subtypes as Predominantly Hyperactive-Impulsive (ADHD-HI), Predominantly Inattentive (ADHD-I), and Combined (ADHD-C). Neuroanatomically though we do not yet know if these clinical subtypes reflect distinct aberrations in underlying brain organization. We imaged 34 ADHD participants defined using DSM-IV criteria as ADHD-I (n = 16) or as ADHD-C (n = 18) and 28 matched typically developing controls, aged 8-17 years, using high-resolution T1 MRI. To quantify neuroanatomical organization we used graph theoretical analysis to assess properties of structural covariance between ADHD subtypes and controls (global network measures: path length, clustering coefficient, and regional network measures: nodal degree). As a context for interpreting network organization differences, we also quantified gray matter volume using voxel-based morphometry. Each ADHD subtype was distinguished by a different organizational profile of the degree to which specific regions were anatomically connected with other regions (i.e., in "nodal degree"). For ADHD-I (compared to both ADHD-C and controls) the nodal degree was higher in the hippocampus. ADHD-I also had a higher nodal degree in the supramarginal gyrus, calcarine sulcus, and superior occipital cortex compared to ADHD-C and in the amygdala compared to controls. By contrast, the nodal degree was higher in the cerebellum for ADHD-C compared to ADHD-I and in the anterior cingulate, middle frontal gyrus and putamen compared to controls. ADHD-C also had reduced nodal degree in the rolandic operculum and middle temporal pole compared to controls. These regional profiles were observed in the context of no differences in gray matter volume or global network organization. Our results suggest that the clinical distinction between the Inattentive and Combined subtypes of ADHD may also be reflected in distinct aberrations in underlying brain organization.

Informatização das visitas médicas em uma unidade de emergência / Informatization of medical visits in an emergency unit / Informatización de las visitas médicas en una unidad de emergencia

A visita médica é uma das rotinas mais importantes na Unidade de Emergência, onde o profissional informa a evolução, discute indicações de realização e/ou interpretação de exames e procedimentos, permitindo o raciocínio clínico com a eventual decisão da conduta a ser tomada. Desta forma, as visitas médicas geram uma enorme quantidade de informações para o diagnóstico e tratamento mais precisos. OBJETIVO: Desenvolver um protótipo adaptável a diferentes dispositivos para a informatização da visita médica na Divisão de Cirurgia de Urgência e Trauma da UE­HC/FMRP da USP. MÉTODO: Realizado em fases: Levantamento de requisitos através de reuniões e visitas aos diversos setores hospitalares, elaboração de uma ficha modelo para destacar as necessidades no momento da visita, adaptação desta ficha para um protótipo informatizado, e aplicação de testes "in loco". RESULTADOS E DISCUSSÃO: O protótipo foi testado por residentes da UE­HC/FMRP levando em consideração usabilidade e fluxo dos dados durante os atendimentos. Obtivemos os resultados esperados e feedbacks de idéias para a melhoria da plataforma em estudos futuros.

A medical visit is one of the most important routines in the Emergency Unit, where staff informs evolution, discusses indications of achievement and / or interpretation of tests and procedures, allowing clinical reasoning with any decision on the action to be taken. Thus, the medical visits generate an enormous amount of information for more accurate diagnosis and treatment. OBJECTIVE: To develop an adaptable prototype to different devices for the computerization of medical visit in the Emergency and Trauma Surgery Division UE-HC / FMRP USP. METHOD: Conducted in phases: Requirements elicitation through meetings and visits to the various hospital departments, developing a model form to highlight the needs at the time of the visit, adaptation of this form for a computerized prototype, and applicationtesting "in loco". RESULTS AND DISCUSSION: The prototype was tested by residents of UE-HC / FMRP taking intoaccount usability and flow of data during the calls. We obtained the expected results and feedbacks of ideas to improvethe platform in future studies.

Informatização da admissão e internação hospitalar e, seguimento ambulatorial de pacientes traumatizados / Computerization of admission and hospitalization and outpatient follow-up of patients traumatized / Informatización de admisión y hospitalización y seguimiento ambulatorio de pacientes traumatizados

Os atendimentos em situação de urgência e emergência abrangem grande parcela das ocorrências médicas no mundo. Dentro de uma unidade de emergência o cenário se torna cada vez mais delicado e conforme o nível de complexidade de cada atendimento aumenta as taxas de erros são maiores. Para um atendimento seguro e de qualidade, a consistência das informações relacionadas ao atendimento e a facilidade de acesso a elas são fundamentais. OBJETIVO: Desenvolver um sistema web para a informatização da admissão e internação hospitalar, e seguimento ambulatorial de pacientes vítimas de trauma na Unidade de Emergência do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. MÉTODO: Realizado em fases: Levantamento de requisitos através de reuniões e visitas aos diversos setores hospitalares, desenvolvimento do sistema em versões funcionais, e aplicação de testes "in loco". RESULTADOS E DISCUSSÃO: O protótipo foi testado por residentes da UE­HC/FMRP considerando usabilidade e fluxo dos dados durante os atendimentos e obtivemos resultados significantes e idéias para a melhoria da plataforma em estudos futuros.

The calls for urgent and emergency situation cover large portion of medical occurrences in the world. Within an emergency unit the scenario becomes increasingly delicate and as the level of complexity of each service increases error rates are higher. For a safe and quality service, the consistency of the information related to compliance and ease of access to them are key. OBJECTIVE: Develop a web system for the computerization of admission and hospitalization, and outpatient follow-up trauma patients at the Emergency Unit of the Hospital of Ribeirão Preto Medical School Clinical, University of Sao Paulo. METHOD: Conducted in phases: Requirements elicitation through meetings and visits to the various hospital departments, development of the system in functional versions, and application testing "in loco". RESULTS AND DISCUSSION: The prototype was tested by residents of EU-HC / FMRP considering usability and flow of data during the calls and obtained significant results and ideas to improve the platform in future studies.

Positive effects of auditory cue in locomotor pattern of people with Parkinson's disease (off and on medication) / Efeito positivo da dica auditiva no padrão locomotor de pacientes com doença de Parkinson

Gait disorders are identified in people with Parkinson's disease. The aim of this study was to investigate the effect of auditory cues and medication on kinematic, kinetic and EMG parameters, during different gait phases of people with PD and healthy elderly. Thirty subjects distributed in two groups (Group 1, PD patients off and on medication; Group 2, healthy elderly) participated in this study and were instructed to walk in two experimental conditions: non-cued and cued. Therefore, kinematic, kinetic and electromyography analyses were utilized to investigate the locomotor pattern. Changes in locomotor pattern (greater muscular activity) with auditory cue were observed for PD patients. Regarding the medication, locomotor parameter improvement was observed after levodopa intake in association with the auditory cue. These results confirm the hypothesis about the external cues therapy that could be used as a complement to drug therapy to achieve improvement in the locomotor pattern of PD patients

Mudanças na marcha são identificadas em pacientes com doença de Parkinson (DP). O objetivo deste estudo foi investigar o efeito da dica auditiva e do medicamento nos parâmetros cinemáticas, cinéticos e eletromiograficos durante diferentes fases da marcha em pacientes com DP e idosos sadios. 30 indivíduos distribuídos em dois grupos (Grupo 1, pacientes com DP; Grupo 2, idosos sadios) participaram deste estudo e foram instruídos a realizarem duas tarefas experimentais: marcha com e sem dica auditiva. Análise cinemática, cinética e eletromiográficas foram utilizadas para investigar o padrão locomotor. Mudanças no padrão locomotor (maior ativação muscular) foram observadas para os pacientes com DP. Em relação à medicação, melhoras no padrão locomotor foram observadas após a ingestão da levodopa em associação com a dica auditiva. Estes resultados confirmam a hipótese sobre a terapia com dicas externas, que pode ser utilizada como um complemento à terapia medicamentosa para melhorar o padrão locomotor de pacientes com DP

Evaluation of passenger health risk assessment of sustainable indoor air quality monitoring in metro systems based on a non-Gaussian dynamic sensor validation method.

Sensor faults in metro systems provide incorrect information to indoor air quality (IAQ) ventilation systems, resulting in the miss-operation of ventilation systems and adverse effects on passenger health. In this study, a new sensor validation method is proposed to (1) detect, identify and repair sensor faults and (2) evaluate the influence of sensor reliability on passenger health risk. To address the dynamic non-Gaussianity problem of IAQ data, dynamic independent component analysis (DICA) is used. To detect and identify sensor faults, the DICA-based squared prediction error and sensor validity index are used, respectively. To restore the faults to normal measurements, a DICA-based iterative reconstruction algorithm is proposed. The comprehensive indoor air-quality index (CIAI) that evaluates the influence of the current IAQ on passenger health is then compared using the faulty and reconstructed IAQ data sets. Experimental results from a metro station showed that the DICA-based method can produce an improved IAQ level in the metro station and reduce passenger health risk since it more accurately validates sensor faults than do conventional methods.

Ensino sem erro e aprendizagem de discriminação / Errorless learning and discrimination learning / Aprendizaje sin error y la discriminación aprendizaje

O termo aprendizagem sem erro tem sido utilizado para se referir, de maneira ampla, à programação de contingências de ensino que resultam em desempenhos precisos ou com pouco erro. A ocorrência de erros durante a aprendizagem tem sido considerada uma parte importante e necessária à aprendizagem na cultura e no meio acadêmico. Na Análise do Comportamento os erros e suas implicações para a aprendizagem são investigados em estudos sobre controle de estímulos e os resultados indicam que erros podem interferir na precisão de desempenhos já aprendidos, gerar comportamentos emocionais, esquiva da tarefa e/ou do professor. Neste estudo, são apresentados diferentes procedimentos de modificação gradual de estímulos para ensinar discriminações, que podem gerar aprendizagem sem erro, e os fatores que afetam a eficácia dessas contingências de ensino. Esses procedimentos necessitam ser mais amplamente divulgados, por serem contribuições importantes da Análise do Comportamento para contextos aplicados, especialmente para o desenvolvimento de tecnologias de ensino quando métodos tradicionais fracassam.

The term errorless learning is largely used to refer to programming teaching contingencies which result in accurate performances or learning without errors. The occurrence of errors during learning has been considered an important and necessary part of learning in cultural and academic contexts. Errors and their implications for learning are investigated in behavioral analytic studies on stimuli control and their results indicate that errors can affect the accuracy of an already established performance, generate emotional behaviors, and avoidance of the task or teacher. The present study describes different procedures with gradual stimulus change, to teach discrimination skills with none or few errors, and the factors that affect the efficacy of those discriminative training. Such procedures are a relevant contribution from behavior analysis to applied contexts, especially for the development of educational technologies when traditional methods fail.

El término aprendizaje sin error se ha utilizado para referirse, en general, la programación de contingencias de enseñanza que se traducen en rendimientos precisos o con poco errores. La ocurrencia de errores durante el aprendizaje se ha considerado importante y necesario para el aprendizaje en la cultura y en la academia. En el Análisis de la Conducta errores y sus implicaciones para el aprendizaje son investigados en los estudios sobre control de estímulos y los resultados indican que errores puede afectar la precisión de rendimiento ya aprendido, generar comportamientos emocionales, evitación de la tarea o del maestro. En este texto, se presentarán diferentes procedimientos de modificación gradual de estímulos para enseñar la discriminación, que puede generar el aprendizaje sin error y los factores que afectan la efectividad de estas contingencias. Estos procedimientos deben difundirse más ampliamente, constituyen importantes contribuciones para contextos de análisis aplicado del comportamiento, especialmente para el desarrollo de tecnologías educativas cuando fallan los métodos tradicionales.

Prenatal development of the fetal thoracic sympathetic trunk in sheep (Ovis aries).

This study aims at clarifying the detailed morphological and topographical changes of the thoracic part of the sympathetic trunk of sheep during fetal development. Bilateral micro-dissection of the thoracic sympathetic trunk was performed on 40 sheep fetuses aged 6-20 weeks (18 males and 22 females) under a stereomicroscope. The cervicothoracic ganglion (CTG) was observed on 75/80 sides (93.7%) and was composed of the caudal cervical and the first thoracic ganglia on 45/80 sides (56.2%), and of the caudal cervical and the first two thoracic ganglia on 30/80 sides (37.5%). The presence of the two last (12th-13th) thoracic ganglia was not constant. The influence of the sex, the side of the body, and the ages of the fetus on the morphology and topography of the thoracic sympathetic trunk in sheep were identified. In spite of the differences in the morphology and topography of the thoracic sympathetic trunk between early and late fetal developments, the morphology and topography of the older fetal thoracic sympathetic trunk tended to be similar to that of the adult sheep. To comprehend the comparative morphology of the fetal thoracic sympathetic trunk more completely, our results were compared with previous studies. Consequently, differences and similarities in the composition and position of the CTG, presence of single caudal cervical ganglion without fusion to the thoracic ganglia, and absence of the thoracic ganglia, and presence of splitting of the interganglionic branch were found among sheep, pig, and human fetuses. Therefore, sheep might be the appropriate animal model to be applied in human sympathetic nervous system.

Dicas de aprendizagem auxiliam as crianças com TDC na aquisição de uma habilidade motora complexa? / Does learning cues help children with DCD on the acquisition of a complex motor skill? / Instrucciones ayudam a niños com TDC en el aprendizaje de una habilidad motora compleja?

O objetivo do estudo foi analisar se as dicas de aprendizagem auxiliam crianças com TDC na aquisição de uma habilidade motora complexa. Dez crianças com TDC e 14 de desenvolvimento típico, de 9 a 11 anos, foram divididas nos grupos TDC com dicas (TDCD), TDC sem dicas (TDCS), desenvolvimento típico com dicas (GDTD) e desenvolvimento típico sem dicas (GDTS). As crianças participaram de sete aulas, durante três semanas, para a aprendizagem do rolamento peixe, com o uso das dicas "empurre o chão", "coloque a mão o mais longe possível" e "queixo no peito". Os resultados não foram estatisticamente significantes entre os grupos, o que evidencia que as dicas não apresentaram efeito positivo na aprendizagem do rolamento peixe.

The objective was to analyze if learning cues help children with Developmental Coordination Disorder (DCD) on the acquisition of a complex motor skill. The sample consisted of ten children with DCD and 14 children with typical development, from 9 to 11 years, divided into the groups DCD with cues (DCDC), DCD without cues (DCDW), typical development with cues (TDC) and typical development without cues (TDW). The children participated in seven classes, during three weeks, to learn to dive roll. Cues used were "push the ground", "place your hands as far as possible" and "chin on the chest". The results weren’t statistically different among the groups, which indicate that cues didn’t show significant effect in learning of the dive roll.

La finalidad fue analizar si las instrucciones ayudan a los niños con el Desarrollo de la coordinación (TDC) en el aprendizaje de una habilidad motora compleja. Diez niños con DCD y 14 con desarrollo típico, 9-11 años, divididos en los grupos TDC con las instrucciones (TDCD), TDC sin las instrucciones (TDCS), desarrollo típico con las instrucciones (GDTD) y desarrollo típico sin las instrucciones (GDTS). Los niños participaran de siete clases por tres semanas para aprender la rotación-pez con el uso de las instrucciones "empuja el suelo", "pon las manos más lejos posible" y "barbilla en el pecho". Los resultados no fueron estadísticamente significativos entre los grupos, lo que demuestra que las instrucciones no señalaron ningún efecto positivo en el aprendizaje de la rotación-pez.