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Introducción. Anudar es una de las habilidades quirúrgicas esenciales y de su correcta ejecución dependen procesos de vital importancia. La adquisición de estas competencias requiere trabajo motor, entornos amigables y realistas. Una estrategia para facilitar el aprendizaje de la técnica de anudado es generar instrumentos de simulación accesibles. Métodos. Se presenta un simulador de nudos quirúrgicos, construido con materiales de bajo costo y asequibles para la población en general, con un presupuesto de aproximadamente $5.000 COP (US$ 1,23). Resultados. Se desarrolló un simulador de nudos quirúrgicos que, al fijarse a la extremidad inferior desde una posición sentada, proporciona una superficie estable para llevar a cabo la práctica de anudado de manera efectiva. Conclusión. La cirugía moderna considera la seguridad del paciente como la principal prioridad, por lo que ya no es apropiado adoptar un método de formación de "ver uno, hacer uno, enseñar uno". Es la práctica constante mediante simuladores, el método más adecuado. Este trabajo presenta una alternativa de aprendizaje ininterrumpido de las técnicas quirúrgicas relacionadas con los nudos.

Introduction. Knotting is one of the essential surgical skills and vitally important processes that depends on its correct execution. The acquisition of these skills requires motor work, friendly and realistic environments. A strategy to facilitate learning the knotting technique is to generate accessible simulation instruments. Methods. A surgical knot simulator is presented, built with low-budget materials and affordable for the general population, with a budget of approximately $5,000 COP (US$ 1.23). Results. A surgical knot simulator has been developed in a way that, when attached to the thigh of a lower extremity from a seated position, provides a stable surface to effectively perform knot tying practice. Conclusion. Modern surgery considers patient safety as the top priority, so it is no longer appropriate to adopt a "see one, do one, teach one" training method. Constant practice using simulators is the most appropriate method. This work presents an alternative for uninterrupted learning of surgical techniques related to knots.

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BACKGROUND: Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication. METHODS: Market research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher's Exact Test. RESULTS: Gastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05). CONCLUSIONS: The WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries.

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Introduction: Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation. Methods: The model was constructed using PVC pipe wrapped in neoprene fabric. Hemorrhoidal nipples and the pectineal line were also simulated using fabric and sewing threads. The procedure is performed with conventional anoscope and ligature forceps. Conclusion: The device in question is a low-cost simulation model designed to train the skills required to perform a rubber band ligation and review the basic anatomy of the anal canal during anoscopy. Given these qualities, the model can be used for academic training due to its low cost and simplicity of application. (AU)

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Resumo: Introdução: Diante da globalização, de cenários de crise e de situações imprevisíveis, surge a necessidade do desenvolvimento de lideranças capazes de retornar as situações à sua normalidade. Nesse cenário, a liderança autêntica, apresenta uma proposta inovadora, baseada nos conhecimentos, habilidades e atitudes da vida do líder. Parte dessa tríade, as habilidades, são divididas, teoricamente, em hard skiils (habilidades técnicas) e soft skills (habilidades pessoais e relacionamento). No contexto de trabalho da enfermagem, o enfermeiro ocupa lugar de destaque, perpassando pelas dimensões do gerenciamento e assistência, necessitando aperfeiçoar tais habilidades. Por ser a liderança autêntica, um processo de expressão íntima de quem nós somos, para que tais habilidades possam ser aprimoradas, é preciso desenvolver a autoconsciência por meio de processos de autoavaliação e autodesenvolvimento. Objetivo: Elaborar e validar instrumento de autoavaliação de habilidades pessoais para liderança autêntica em enfermagem. Método: Estudo metodológico, que visa a construção e validação de instrumento de autoavaliação de habilidades pessoais para a liderança autêntica em enfermagem, cujo nome dado foi "LEADERSKILLS". A validação do conteúdo, se deu mediante a técnica Delphi Online. Foi considerado como Índice de Validade de Conteúdo (IVC) >=0,85 na primeira rodada e IVC >=0,80 na segunda rodada, baseado no quantitativo de especialistas e nas características do construto. Fizeram parte do painel de especialistas profissionais com no mínimo cinco pontos do critério para a seleção de especialistas de Joventino (2010). Participaram da primeira rodada 13 profissionais de enfermagem de todas as regiões do Brasil e da segunda, 5 profissionais. As avaliações transcorreram na primeira rodada, via plataforma Survey Monkey®, e a segunda pelos e-mails de resposta dos participantes, totalizando duas rodadas de consenso. Resultados: A primeira etapa de elaboração do construto permitiu gerar um esboço do instrumento que foi submetido a pré-teste aos participantes do grupo de pesquisa. Essa préavaliação, permitiu observar a necessidade de melhoria de aspectos visuais, que passaram por modificações com o designer gráfico. O resultado dessas alterações, gerou a primeira versão do instrumento que foi encaminhado para avaliação dos juízes. Foram avaliadas quatro categorias de dados, tais como: conteúdo, linguagem, layout, motivação e cultura. Dentro desses itens, foram elaboradas 17 questões de múltipla escolha e duas dissertativas. Do total de questões avaliadas, apenas duas (questão 11 e questão 17) não obtiveram consenso na primeira rodada. A segunda rodada de consenso culminou na validação do conteúdo do "LEADESKILLS". Conclusão: Dessa forma, a pesquisa permitiu atingir os objetivos propostos, corroborando com a literatura, a qual sinaliza a escassez e necessidade de estudo à temática das soft skills. Sendo assim, a construção desse instrumento, será um coadjuvante para o autoconhecimento e autodesenvolvimento, uma vez que fomentará o debate dos profissionais enfermeiros.

Abstract: Introduction: In the face of globalization, crisis scenarios and unpredictable situations, there is a need for the development of leaders capable of returning situations to their normality. In this scenario, authentic leadership presents an innovative proposal, based on the knowledge, skills and attitudes of the life of the leader. Part of this triad, the skills, are divided, theoretically, into hard skiils (technical skills) and soft skills (personal skills and relationship). In the context of nursing work, nurses occupy a prominent place, going through the dimensions of management and care, needing to improve these skills. Because it is authentic leadership, a process of intimate expression of who we are, so that such skills can be improved, it is necessary to develop self-awareness through processes of self-assessment and self-development. Objective: To develop and validate a self-assessment instrument of personal skills for authentic leadership in nursing. Method: Methodological study, which aims to construct and validate a self-assessment instrument of personal skills for authentic leadership in nursing, whose given name was "LEADERSKILLS". The content was validated using the Delphi Online technique. It was considered as Content Validity Index (CVI) >=0.85 in the first round and CVI >=0.80 in the second round, based on the number of experts and the characteristics of the construct. They were part of the panel of professional experts with at least five points of the criterion for the selection of experts of Joventino (2010). The first round of 13 nursing professionals from all regions of Brazil and the second, 5 professionals participated in the first round. The evaluations took place in the first round, via survey monkey® platform, and the second by the participants' response emails, totaling two rounds of consensus. Results: The first stage of construct elaboration allowed to generate an outline of the instrument that was submitted to pre-test to the participants of the research group. This pre-evaluation allowed us to observe the need to improve visual aspects, which underwent modifications with the graphic designer. The result of these changes generated the first version of the instrument that was forwarded for evaluation by the judges. Four categories of data were evaluated, such as: content, language, layout, motivation and culture. Within these items, 17 multiple choice questions and two dissertationquestions were elaborated. Of the total number of questions evaluated, only two (question 11 and question 17) did not reach consensus in the first round. The second round of consensus culminated in the validation of the content of the "LEADESKILLS". Conclusion: Thus, the research allowed to achieve the proposed objectives, corroborating the literature, which signals the scarcity and need to study the theme of soft skills. Thus, the construction of this instrument will be an adjunct to self-knowledge and self-development, since it will foster the debate of nursing professionals.

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Purpose: To evaluate the viability of the porcine vas deferens as a realistic microsurgical training model for vasectomy reversal Methods: The model uses swine testicles (vas deferent), which are usually discarded in large street markets since they are not part of Brazilian cuisine. The spermatic cord was carefully dissected, and the vas deferens were isolated, measuring 10 cm in length. A paper quadrilateral with 5 cm2 was built to delimit the surgical training field. The objective of the model is to simulate only the microsurgical step when the vas deferens are already isolated. The parameters analyzed were: feasibility for reproducing the technique, patency before and after performing the vasovasostomy, cost of the model, ease of acquisition, ease of handling, execution time, and model reproducibility. Results: The simulator presented low cost. All models made were viable with a texture similar to human, with positive patency obtained in 100% of the procedures. The internal and external diameters of the vas deferens varied between 0.2-0.4 mm and 2-3 mm, respectively, with a mean length of 9 ± 1.2 cm. The total procedure time was 43.28 ± 3.22 minutes. Conclusions: The realistic model presented proved to be viable for carrying out vasectomy reversal training, due to its low cost, easy acquisition, and easy handling, and providing similar tissue characteristics to humans.

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Objetivo:Descrever a construção de tecnologia social para prevenção de úlceras em pés de pessoas diabéticas. Método:Estudo de abordagem qualitativa, caráter descritivo-exploratório, corresponde a uma pesquisa ação que foi realizada com 11 enfermeiras integrantes da Rede de Atenção Primária à Saúde do Município de Salvador, Bahia, Brasil. Esta pesquisa foi norteada pelaperspectiva Crítico-Libertadora de Paulo Freire. Resultados:A construção da tecnologia social para prevenção de úlceras em pés de pessoas diabéticas se deu com a participação de enfermeiras atuantes na APS, as quais coletivamente propuseram os elementos necessários para compor a planilha online de rastreio no Google Drive. Tais elementos abarcam as necessidades de identificação do paciente, conhecimento da história clínica, acompanhamento da diabetes e suas possíveis complicações, itens para o rastreio, além de determinar encaminhamentos. Considerações finais:A tecnologia social se constitui como facilmente replicável, de baixo custo e com relevância social. Sua utilização alcança não apenas enfermeiras, mas abrange outros profissionais de saúde, assim como tem impacto direto na qualidade de vida de pessoas com diabetes.

Objective: To describe the construction of social technology for the prevention of foot ulcers in diabetic people. Method: Study with a qualitative approach, with a descriptive-exploratory character, corresponding to action research that was carried out with 11 nurses who are members of the Primary Health Care Network in the city of Salvador, Bahia, Brazil. This research was guided by Paulo Freire's Critical-Liberating perspective. Results:The construction of social technology for the prevention of foot ulcers in diabetic people took place with the participation of nurses working in the PHC, who collectively presented the necessary elements to compose the online tracking worksheet on Google Drive. Such elements include the needs for patient identification, knowledge of the clinical history, monitoring of diabetes and its possible complications, items for tracking, in addition to determining the referral.Final considerations: Social technology is easily replicable, low cost and socially popular. Its use reaches not only nurses, but also other health professionals, as well as having a direct impact on the quality of life of people with diabetes.

Objetivo: Describir la construcción de tecnología social para prevenir úlceras en los pies en personas diabéticas. Método:Estudio con enfoque cualitativo, de carácter descriptivo-exploratorio, correspondiente a una investigación-acción que se realizó con 11 enfermeros integrantes de la Red de Atención Primaria de Salud del Municipio de Salvador, Bahía, Brasil. Esta investigación estuvo guiada por la perspectiva Crítico-Liberador de Paulo Freire. Resultados:La construcción de tecnología social para prevenir úlceras del pie en personas diabéticas se realizó con la participación de enfermeros que trabajan en la APS, quienes colectivamente propusieron los elementos necesarios para la composición de la hoja de seguimiento en línea en Google Drive. Estos elementos cubren las necesidades de identificación del paciente, conocimiento de la historia clínica, seguimiento de la diabetes y sus posibles complicaciones, elementos de tamizaje, además de determinar derivaciones. Consideraciones finales:La tecnología social es fácilmente replicable, de bajo costo y socialmente relevante. Su uso llega no sólo al personal de enfermería, sino también a otros profesionales de la salud, además de tener un impacto directo en la calidad de vida de las personas con diabetes.

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ABSTRACT Background: training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for training centers. Methods: we built a low-cost simulator for intra-abdominal bleeding with inexpensive materials, such as a manikin chest, latex tubes, silicone rubber, and waterproof fabric, seeking to mimic the abdominal viscera and vessels and their anatomical correlations. An IV infusion set allowed simulated blood to flow under pressure, and the blood flowed freely during simulation. After obtaining a functional model, we selected general surgeons to validate the simulator and its use in teaching surgery. We used the content validity index (CVI), with a cutoff of 0.9. Results: the cost of building the prototype was US$71,00 in 2021, accounting for the purchase of the various necessary materials. Twelve raters participated in the validation tests. The results obtained from the feedback survey showed a good evaluation of all items, especially the recognition of the injured vessel, access to the vascular injury, hemostasis by manual compression, and hemostatic suturing. Conclusion: the proposed simulator obtained good results in scenarios of intra-abdominal bleeding from large vessels, as well as for hemostasis by manual compression and suturing. It proved to be a useful tool for training in critical intra- abdominal bleeding situations, while maintaining a low cost of building.

RESUMO Introdução: o treinamento em situações críticas em Cirurgia é determinante para o desfecho seguro. O uso de simuladores é bastante consolidado, embora muitos apresentem custos muito elevados, sendo necessária a busca de soluções financeiramente viáveis para os centros de treinamento. Métodos: construímos um simulador de sangramento intra-abdominal de baixo custo com materiais simples como tronco de manequim, tubos de látex, borracha de silicone e tecido impermeável, buscando representar vísceras abdominais e vasos e suas correlações anatômicas. Um sistema de tubos e equipos de soro permitiu o fluxo, sob pressão, de sangue simulado, que vertia livremente durante a simulação. Após a obtenção de modelo funcional, selecionamos cirurgiões gerais para a validação do simulador e seu uso no ensino de Cirurgia. Utilizamos o Índice de Validação de Concordância (IVC), com corte de 0,9. Resultados: a construção do protótipo resultou em gasto de US$71,00 em valores de 2021, destinados à aquisição dos diversos materiais necessários. Doze avaliadores participaram dos testes de validação. Os resultados obtidos dos questionários demonstraram uma boa avaliação em todos os itens, destacando-se o reconhecimento do vaso traumatizado, o acesso à lesão vascular, o controle hemostático por pressão direta assim como por sutura direta da lesão. Conclusão: o simulador proposto obteve bons resultados em cenários de sangramento abdominal de grandes vasos, assim como o controle hemostático do mesmo por pressão direta e sutura. Mostrou-se ferramenta útil para a adaptação a situações de estresse no treinamento em sangramentos intra-abdominais, além de manter baixo custo de construção.

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ABSTRACT Purpose: To introduce a new low-cost simulation model for training basic surgical skills. Methods: The training model was made from a mixture of 20 g of acetic silicone with 11 g of maize starch. Validation consisted of serial training sessions, evaluating the mean pre- and post-training time and the mean final score according to the global rating scale. Results: A decrease in the time required to perform the sutures was observed, comparing the average post and pre-training time of each training day, with a significant correlation between the order of training and the time for performing the simulation. Conclusions: The presented model proved to be capable of simulating the basic suture training skills. It is easy to make, has low cost, and can be easily reproduced in educational institutions.

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In the last 30 years soils decreased 73 % of their productive capacity in the world. One of the main reasons for this decrease has been the politics implemented, as well as the absence of opportunity for the small producer to implement improvement strategies that can increase their productivity in the field. Therefore, in this research a soil measurement system is proposed for small farmers, based on the design of two sensors of low cost: (i) Apparent electrical conductivity (ECa) sensor and (ii) moisture sensor. These measurement variables have the particularity that their characteristics can be associated with the physical properties of the soil for decision-making. The sensors developed in this work employ two techniques: Wenner's method for ECa and electrical impedance measurement to identify the dielectric permittivity associated with the water content of the soil. The system is controlled by the Raspberry Pi 3 board through developed software that allows correlating data with its geolocation. The device was tested in controlled laboratory measurements with calibrated instruments, obtaining a coefficient of . Finally, on-site tests were made to validate their use for small farmers.

Durante los últimos 30 años, los suelos han disminuido un 73 % su capacidad productiva, a nivel mundial. Una de las principales razones para esta cifra a la baja son las políticas implementadas, así como la falta de oportunidad para que el pequeño productor adopte estrategias de mejora, con lo cual, pueda aumentar la productividad. Por lo anterior, en esta investigación, se propone un sistema de medición de suelo para pequeños productores, a partir del diseño de dos sensores de bajo costo: (i) sensor de conductividad eléctrica aparente (CEa) y (ii) sensor de humedad. Estas variables de medición tienen la particularidad que sus características se pueden asociar a las propiedades físicas del suelo, para tomar decisiones. Los sensores desarrollados en este trabajo usan dos técnicas: el método de Wenner, para la CEa y la medición de impedancia eléctrica, para identificar la permitividad dieléctrica asociada con el contenido de agua del suelo. El sistema es controlado mediante la tarjeta Raspberry Pi 3, a través de un software desarrollado, que permite correlacionar los datos con su geolocalización. El dispositivo, se probó en mediciones controladas en laboratorio, con instrumentos calibrados, obteniendo un coeficiente . Finalmente, se hicieron pruebas in situ, con el fin de validar su uso por pequeños agricultores.

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BACKGROUND: To evaluate the efficacy of retinal photography obtained by undergraduate students using a smartphone-based device in screening and early diagnosing diabetic retinopathy (DR). METHODS: We carried out an open prospective study with ninety-nine diabetic patients (194 eyes), who were submitted to an ophthalmological examination in which undergraduate students registered images of the fundus using a smartphone-based device. At the same occasion, an experienced nurse captured fundus photographs from the same patients using a gold standard tabletop camera system (Canon CR-2 Digital Non-Mydriatic Retinal Camera), with a 45º field of view. Two distinct masked specialists evaluated both forms of imaging according to the presence or absence of sings of DR and its markers of severity. We later compared those reports to assess agreement between the two technologies. RESULTS: Concerning the presence or absence of DR, we found an agreement rate of 84.07% between reports obtained from images of the smartphone-based device and from the regular (tabletop) fundus camera; Kappa: 0.67; Sensitivity: 71.0% (Confidence Interval [CI]: 65.05-78.16%); Specificity: 94.06% (CI: 90.63-97.49%); Accuracy: 84.07%; Positive Predictive Value (PPV): 90.62%; Negative Predictive Value (NPV): 80.51%. As for the classification between proliferative diabetic retinopathy and non-proliferative diabetic retinopathy, we found an agreement of 90.00% between the reports; Kappa: 0.78; Sensitivity: 86.96%; (CI: 79.07-94.85%); Specificity: 91.49% (CI: 84.95-98.03%); Accuracy: 90.00%; PPV: 83.33%; NPV: 93.48%. Regarding the degree of classification of DR, we found an agreement rate of 69.23% between the reports; Kappa: 0.52. As relating to the presence or absence of hard macular exudates, we found an agreement of 84.07% between the reports; Kappa: 0.67; Sensitivity: 71.60% (CI: 65.05-78.16%); Specificity: 94.06% (CI: 90.63-97.49%); Accuracy: 84.07%; PPV: 90.62%; NPV: 80.51%. CONCLUSION: The smartphone-based device showed promising accuracy in the detection of DR (84.07%), making it a potential tool in the screening and early diagnosis of DR.

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ABSTRACT Objectives: to describe the construction of a low-cost laparoscopy training simulator and evaluate its level of acceptance, impact on learning, and skill development in medical students. Methods: we built a video training simulator using low-cost materials. We then carried out a cross-sectional study, with the use of an applied questionnaire to medical students. Results: 51 medical students participated in the research, of whom 76.47% gained confidence in relation to laparoscopic surgery, 100% stated that the model successfully trained the skills of motor coordination and two-dimensional visual-spatial field, in addition to enabling a greater understanding of laparoscopy. All agreed that the simulator should be used before a real laparoscopic surgery scenario. Conclusion: the construction of the described laparoscopic surgery training simulator proved to be feasible and effective as an educational resource. It was well accepted by medical students, with easy handling, and promoted the development of motor and visual skills in video surgery.

RESUMO Objetivos: descrever a construção de um simulador de treinamento de videocirurgia de baixo custo e avaliar, por meio de sua aplicação, o nível de aceitação, de impacto no aprendizado e de desenvolvimento de habilidades em acadêmicos do curso de medicina. Método: foi construído um simulador, de videotreinamento com uso de materiais de baixo custo. Realizou-se um estudo transversal com a utilização de questionário aplicado a acadêmicos do curso de medicina. Resultados: a pesquisa contou com a participação de 51 acadêmicos de medicina. Após o uso do simulador 76,47% dos pesquisados adquiriram confiança em relação à videocirurgia, 100% afirmaram que o modelo treinou com satisfação as habilidades de coordenação motora e campo visoespacial bidimensional, além de possibilitar maior compreensão da videocirurgia. Todos concordaram que o simulador deveria ser utilizado antes da situação real. Conclusão: a construção do simulador de treinamento em videocirurgia descrito mostrou-se factível e eficaz como recurso educacional. Obteve boa aceitação pelos acadêmicos, com fácil manuseio, capaz de fomentar o desenvolvimento das habilidades motoras e visuais em videocirurgia.

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ABSTRACT Objectives: to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students. Methodology: a paracentesis simulator was built using a mannequin and materials such as plastic bottles, Velcro, polyvinyl chloride sheets and silicone were used. A cross-sectional and experimental study was carried out with undergraduate medical students without previous practical experience with paracentesis, which sought to validate the model, evaluating its benefits in learning and obtaining technical skills. Results: after using the simulator there was an increase of 82.4% in the level of confidence in performing paracentesis in a patient, with 98% of respondents considering that the model fulfilled the simulator function with satisfaction, and 100% considering it useful as a teaching tool. Conclusion: the built simulator was effective as an educational resource, serving as an alternative to high-cost commercial models, allowing for greater accessibility in the use of this tool in medical education.

RESUMO Objetivos: descrever a montagem de simulador de paracentese de baixo custo e avaliar eficácia, aceitação e impacto no aprendizado de acadêmicos do curso de medicina. Método: um simulador de paracentese foi construído a partir de manequim e de materiais como garrafas plásticas, velcro, folhas de policloreto de vinila e silicone. Foi feito estudo transversal com estudantes da graduação do curso de medicina sem experiência real prévia com paracentese, que buscou validar o modelo, por meio da análise de benefícios no aprendizado e na obtenção de habilidades técnicas. Resultados: após o uso do simulador, observou-se aumento de 82,4% no nível de segurança na realização da paracentese em paciente, 98% dos pesquisados consideraram que o uso do modelo cumpriu com satisfação a função de simulador e 100% definiram-no útil como ferramenta de ensino. Conclusão: a montagem do simulador mostrou-se factível e eficaz como recurso educacional. Serviu como alternativa aos modelos comerciais de alto custo e permitiu maior acessibilidade do uso dessa ferramenta na educação médica.

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After a visit to a hydrotherapy laboratory, limited resources for use in lower limbs were noted. For this reason, the goal is to design a water bike from low-cost material. The process took place in three phases: (1) project carried out, (2) prototype construction and (3) bicycle construction. The confection was divided into six parts; the materials used were polyvinyl chloride (PVC) tubes for the construction of sewer system. In addition to PVC materials, other products were used: two plastic pedals; a gel saddle, a seat post, two cranksets, a pipe clamp, a central shaft, two industrial bearings, three 40-millimeter aluminum cylinders and four suction cups. The final product was measured 69 centimeters (cm) in width, 59.05 cm in length; as the seat can be adjusted, the height varies. The prototype ranges from 73 to 102 cm in height and supports up to 85 kilograms (kg). It is concluded that although there is a limitation as to the design of the final product due to the limited formats of the PVC connections and as to the adaptations that must be made so that the final product can support a considerable weight, it is feasible to make a low-cost water exercise bike using PVC as the main material that can be used in the pool. It is noteworthy, however, that this product will still be tested to ascertain functionality as for equipment for clinical practice. (AU)

Após a visita em um laboratório de hidroterapia denotou-se a limitação de recursos para membros inferiores. Devido a isso, o objetivo é elaborar uma bicicleta aquática de material de baixo custo. O processo se deu em três fases: (1) design realizado, (2) produção do protótipo e a (3) construção da bicicleta. A confecção foi dividida em seis partes; os materiais utilizados foram tubos de Policloreto de vinila (PVC) para esgoto predial. Além de materiais de PVC foram utilizados outros produtos: dois pedais de plástico; um selim de gel, um canote, dois pedivelas, uma braçadeira de tubo, um eixo central, dois rolamentos industriais, três cilindros de alumínios 40 milímetros e quatro ventosas. O produto final teve como medida 69 centímetros (cm) de largura, 59,05 cm de comprimento; como o banco pode ser regulado, a altura varia. o protótipo varia entre 73 a 102 cm de altura e suporta até 85 quilogramas. Conclui-se então que embora haja limitação quanto ao design do produto final por conta dos limitados formatos das conexões de PVC e quanto à adaptações que devem ser feitas para que o produto final consiga suportar um peso considerável, é viável a confecção de uma bicicleta ergométrica aquática de baixo custo utilizando o PVC como material principal e que pode ser utilizada na piscina. Destaca-se, entretanto, que este produto ainda será testado para averiguar a funcionalidade quanto equipamento para a prática clínica. (AU)

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Therapeutic hypothermia (TH) using servo-controlled cooling devices has proved to be a safe and effective method to reduce mortality and sequelae in neonates with hypoxic-ischemic encephalopathy (HIE). However, such cooling devices can be expensive and have limited availability in low- and middle-income countries. To evaluate the feasibility and effectiveness of low-cost cooling devices (ice packs) to reach and maintain the target temperature in newborns with moderate or severe HIE. Descriptive retrospective cross-sectional study, including newborns with gestational age ≥35 weeks, weight ≥1800 g, with diagnosis of moderate or severe HIE, submitted to whole body hypothermia using ice packs for 72 hr. Data was obtained from medical records and databases. The thermal curves of each patient, time spent at the target temperature and rewarming time were evaluated. Complications directly related to therapeutic hypothermia, evolution, and early outcomes before hospital discharge were analyzed. Seventy-one newborns met the criteria for TH, and 61 completed the entire cooling period and were included in the final analysis. The average time to reach the target temperature was 1.50 ± 1.3 hr. The mean temperature during the cooling period was 33.5°C (±0.62). 82.32% of the measurements were within the target temperature range (from 33 to 34°C). The following adverse events were observed during TH: pulmonary hypertension 11.3%, arrhythmia 4.2%, and coagulopathy 26.7%. Whole body hypothermia using low-cost devices proved to be an effective method in the absence of availability of servo-controlled devices, representing a plausible option in restricted resource settings.

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Resumo Objetivo: Desenvolver um modelo de treinamento de cirurgias corneanas utilizando uvas. Métodos: Foram empregadas uvas como estruturas que mimetizam o tamanho do globo ocular humano, recobertas com materiais de látex, simulando a pratica de cirurgias de córnea utilizando um sistema de videomagnificação. Foram realizados oito pontos simples. Foi avaliado o tempo de confecção do procedimento. Resultados: Foram realizadas 25 simulações como o modelo descrito. O tempo médio de realização da rafia foi de 34,56 ±5,79 minutos. A análise da correlação entre o tempo e a ordem das cirurgias mostrou uma redução no tempo de confecção. Conclusão: O modelo de treinamento oftalmológico utilizando uvas mostrou-se capaz de simular as etapas básicas do treinamento de suturas microcirúrgicas.

Abstract Objective: Develop a training model for corneal surgery using grapes. Methods: Grapes were used as structures that mimic the size of the human eyeball, covered with latex materials, simulating the practice of corneal surgery using a videomagnification system. Eight simple stitches were performed. The surgical time was evaluated. Results: 25 simulations were carried out as the model described. The mean time taken for the raffia was 34.56 ± 5.79 minutes. The analysis of the correlation between the time and the order of the surgeries showed a reduction in the confection time. Conclusion: The ophthalmic training model using grapes proved to be capable of simulating the basic stages of microsurgery suture training.

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Introdução: Na hemiparesia há uma inadequada descarga de peso nos membros inferiores que geram déficits de equilíbrio, sendo as pranchas de equilíbrio imprescindíveis para avaliação. Objetivo: Verificar a aplicabilidade clínica de uma prancha de baixo custo e da Escala de Equilíbrio de Berg (EEB) na avaliação do equilíbrio e a distribuição de peso nos membros inferiores de pacientes hemiparéticos. Métodos: Estudo piloto, transversal, quantitativo, de inovação tecnológica que realizou avaliação de 21 indivíduos acometidos com Acidente Vascular Encefálico (AVE) por uma prancha de baixo custo. Resultados: Houve predominância de AVE isquêmico e hemiparesia direita. Na avaliação com a prancha, participantes com hemiparesia direita descarregaram maior peso na região do retropé, tanto com os pés juntos quanto na largura do quadril, enquanto os que possuem hemiparesia esquerda houve diferenças nas posições, com os pés juntos, pois a maioria descarregou o peso na região do antepé, enquanto com os pés na largura do quadril descarregaram na região do retropé. Quanto a avaliação pela EEB, as atividades funcionais que necessitavam de maior sustentação obtiveram menores médias, porém não houve correlação estatisticamente significativa com as posições sobre a prancha. Conclusão: A avaliação em saúde por meio da prancha de baixo custo torna-se um instrumento importante para identificar as alterações do equilíbrio e realizar intervenções apropriadas, entretanto não se correlaciona com a Escala de Equilíbrio de Berg. (AU)

Introduction: In hemiparesis the inadequate weight-bearing in the lower limbs generate balance deficits, and balance planks are essential for evaluation. Objective: To verify the clinical applicability of a low-cost board and the Berg Balance Scale (BBS) in the assessment of balance and weight distribution in the lower limbs of hemiparetic patients. Methods: A pilot, cross-sectional, quantitative, technological innovation study carried out an evaluation of 21 individuals affected by stroke with a low-cost plank. Results: Ischemic stroke and right hemiparesis were predominant. In the evaluation with the plank, participants with right hemiparesis unloaded more weight in the hindfoot region, with both feet together and hip width, while those with left hemiparesis showed differences in positions, with feet together, as most unloaded the weight in the forefoot region, while with feet hip width unloaded in the hindfoot region. As for the assessment by BBS, the functional activities that needed more support obtained lower averages; however, there was no statistically significant correlation with the positions on the board. Conclusion: Health assessment using the low-cost plank can be an important tool to identify changes in balance and carry out appropriate interventions, however it does not correlate with Berg Balance Scale. (AU)

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Universalising actions aimed at water supply in rural communities and indigenous populations must focus on simple and low-cost technologies adapted to the local context. In this setting, this research studied the dynamic gravel filter (DGF) as a pre-treatment to household slow-sand filters (HSSFs), which is the first description of a household multistage filtration scale to treat drinking water. DGFs (with and without a non-woven blanket on top of the gravel layer) followed by HSSFs were tested. DGFs operated with a filtration rate of 3.21 m3 m-2.d-1 and HSSFs with 1.52 m3 m-2.d-1. Influent water contained kaolinite, humic acid and suspension of coliforms and protozoa. Physical-chemical parameters were evaluated, as well as Escherichia coli, Giardia spp. cysts and Cryptosporidium spp. oocyst reductions. Removal was low (up to 6.6%) concerning true colour, total organic carbon and absorbance (λ = 254 nm). Nevertheless, HMSFs showed turbidity decrease above 60%, E. coli reduction up to 1.78 log, Giardia cysts and Cryptosporidium oocysts reductions up to 3.15 log and 2.24 log, respectively. The non-woven blanket was shown as an important physical barrier to remove solids, E. coli and protozoa.

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RESUMO Objetivo: apresentar um modelo de baixo custo para treinamento de controle de sangramento com o uso de torniquete e os resultados da avaliação do treinamento. Método: foram utilizados materiais de fácil aquisição e de baixo custo, como espuma de estofado, placa de etileno-acetato de vinila (EVA), bomba plástica de propulsão, recipiente de soro fisiológico, água, tinta escolar, equipos de soro, tubo de látex para garrote e manequins comerciais de perna e de braço. Na montagem, foi criado um sistema de simulação de sangramento ativo que só podia ser controlado com aplicação correta do torniquete. O modelo foi submetido à avaliação de profissionais e acadêmicos. Resultados: o modelo teve semelhança com a anatomia humana, mostrou-se prático no treinamento da contenção de sangramento com uso de torniquete e teve baixo custo financeiro. Conclusão: o modelo para treinamento de controle de sangramento teve excelente aceitabilidade, foi considerado viável para fins educacionais do uso de torniquete e teve baixo custo.

ABSTRACT Objective: to present a low-cost model for bleeding control training with the use of a tourniquet and the results of the training evaluation. Method: low-cost and easy-to-purchase materials, such as upholstery foam, ethylene-vinyl acetate (EVA) sheet, plastic propulsion pump, saline container, water, school paint, serum equipment, rubber tubing for tourniquet, and a leg and an arm of a ghost mannequin, were used. In the model assembly, we created an active bleeding simulation system, which could only be controlled with the correct application of the tourniquet. The model was submitted to professional and academic evaluation. Results: the model was similar to human anatomy, proved to be practical in the bleeding control training with the use of a tourniquet, and had low cost. Conclusion: the model for bleeding control training had excellent acceptability, was considered viable for educational purposes of tourniquet use, and had low cost.

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ABSTRACT BACKGROUND: Esophageal manometry is the most reliable method to evaluate esophageal motility. High resolution manometry (HRM) provides topographic contour colored plots (Clouse Plots) with simultaneous analysis from the pharynx to the stomach. Both solid state and water-perfused systems are available. OBJECTIVE: This study aims to determinate the normative data for a new water-perfused HRM. METHODS: HRM was made in 32 healthy volunteers after 8 hours fasting. HRM system used consisted of a 24-channel water-perfused catheter (Multiplex, Alacer Biomedica, São Paulo, Brazil). The reusable catheter is made of polyvinyl chloride (PVC) with 4.7 mm of diameter. Side holes connected to pressure transducers are spaced 2 cm for the analysis from the pharynx to the lower esophageal sphincter (LES). Holes are spaced 5 mm and 120° in a spiral disposition in the LES area. The sensors encompass 34 cm in total. Upper esophageal sphincter (UES) parameters studied were basal and relaxation pressures. Esophageal body parameters were distal contractile integral (DCI), distal latency (DL) and break. LES parameters studied were basal pressure, integrated residual pressure (IRP), total and abdominal length. Variables are expressed as mean ± standard deviation, median (interquartile range) and percentiles 5-95th. RESULTS: All volunteers (17 males, aged 22-62 years) completed the study and tolerated the HRM procedure well. Percentiles 5-95th range were calculated: Upper Esophageal Sphincter (UES) basal pressure 16.7-184.37 (mmHg), DL: 6.2-9.1 (s), DCI: 82.72-3836.61 (mmHg.s.cm), break: <7.19 (cm), LES basal pressure: 4.89-37.16 (mmHg), IRP: 0.55-15.45 (mmHg). CONCLUSION: The performance and normative values obtained for this low-cost water-perfused HRM seems to be adequate for clinical use.

RESUMO CONTEXTO: Manometria esofágica é o exame mais confiável para avaliar motilidade esofágica. Manometria esofágica de alta resolução (MAER) apresenta um gráfico dinâmico e colorido (Clouse plots) com análise simultânea da faringe ao estomago. Dois tipos de manometria estão disponíveis: estado sólido e por perfusão de água. OBJETIVO: Determinar os valores de normalidade de um novo sistema de manometria de alta resolução. MÉTODOS: MAER foi realizada em 32 voluntários saudáveis após jejum de oito horas. O sistema utilizado é de perfusão de água com 24 sensores (Multiplex, Alacer Biomedica, São Paulo, Brasil). O catéter permanente é feito de cloreto de polivinil (PVC) com 4,7 mm de diâmetro. Os orifícios laterais para conexão com os transdutores de pressão são espaçados de 2 cm para análise da faringe ao esfíncter esofagiano inferior (EEI) e são esparçados em 5mm em forma espiralada com 120° entre orificios. Os sensores no total englobam 34 cm. Para o esfíncter esofágico superior (EES), os parâmetros estudados foram às pressões basal e de relaxamento. Os parâmetros do corpo esofágico foram: integral de contratilidade distal (DCI), latência distal (DL) e quebra. Os parâmetros do EEI inferior foram pressões basal e de relaxamento e pressão de relaxamento integrada (IRP). As variáveis foram expressas em medias ± desvio padrão, medianas (variação de interquartis) e percentis 5-95. RESULTADOS: Todos os voluntários (17 homens, com idade variando entre 22-62 anos) terminaram e toleraram o exame. A variação dos percentis 5-95 foi calculada: pressão basal do esfíncter esofágico superior (EES) foi 16,7-184,37 (mmHg), DL: 6,2-9,1 (s), DCI: 82,72-3836,61 (mmHg.s.cm), quebra: <7,19 (cm), pressão basal do EEI: 4,89-37,16 (mmHg), IRP: 0,55-15,45 (mmHg). CONCLUSÃO: A realização dos testes e os valores de normalidade determinados por este estudo parecem ser adequadas para a prática clínica.

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Objective: The objective of this study was to construct and validate a low-cost simulator to train diabetes mellitus patients and their caregivers on the administration of insulin. Method: Action research study with a qualitative approach, through a validation methodological study. Results: A low-fidelity simulator was constructed with the areas recommended for insulin administration adapted to allow skill training. Validation was done by nine experts on the subject. Conclusions: The prototype has low cost and greater anatomical functional fidelity than the models currently available in the market. Implications for practice: The simulator developed can be used by health professionals, caregivers or by the patients themselves as a tool in the training for insulin administration. Its use may favor the identification of critical points related to the application technique, allowing the planning of more directive and effective educational interventions.

Objetivo: Este estudio tuvo como objetivo la construcción y validación de un simulador de bajo costo para uso en la capacitación de pacientes con diabetes mellitus y de sus cuidadores para la aplicación de insulina. Método: Investigación-acción de abordaje cualitativo y estudio metodológico de validación. Resultados: Se ha construido un simulador de baja fidelidad con las áreas recomendadas para la aplicación de insulina adaptadas para permitir el entrenamiento de la habilidad. La validación fue hecha por nueve expertos en el tema. Conclusiones: El prototipo presenta bajo costo y mayor fidelidad anatómica funcional que los modelos actualmente disponibles en el mercado. Implicaciones para la práctica: El simulador desarrollado puede ser utilizado por profesionales de la salud, cuidadores o por los propios pacientes como herramienta en la capacitación para aplicación de insulina. Su uso puede favorecer la identificación de puntos críticos relacionados con la técnica de aplicación, permitiendo la planificación de intervenciones educativas más directivas y eficaces.

Objetivo: Este estudo teve como objetivo a construção e validação de um simulador de baixo custo para uso na capacitação de pacientes com diabetes mellitus e de seus cuidadores para a aplicação de insulina. Método: Pesquisa-ação de abordagem qualitativa e estudo metodológico de validação. Resultados: Foi construído um simulador de baixa fidelidade com as áreas recomendadas para aplicação de insulina adaptadas para permitir o treinamento da habilidade. A validação foi feita por nove experts no assunto. Conclusões: O protótipo apresenta baixo custo e maior fidelidade anatômico funcional do que os modelos atualmente disponíveis no mercado. Implicações para prática: O simulador desenvolvido pode ser utilizado por profissionais da saúde, cuidadores ou pelos próprios pacientes como ferramenta na capacitação para aplicação de insulina. Seu uso pode favorecer a identificação de pontos críticos relacionados a técnica de aplicação, permitindo o planejamento de intervenções educacionais mais diretivas e eficazes.

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