BACKGROUND: Paracentesis is a routine medical procedure quite relevant in clinical practice. There are risks of complications related to paracentesis, so it is essential a proper trainee for the younger practicer. OBJECTIVE: The article describes the construction and the application of a low cost paracentesis simulator for undergraduate medical students and it also describes the perception of students about the simulator as well. METHODS: A low-cost model was developed by the Program of Tutorial Education for training medical students during three editions of an undergraduate theoretical-practical course of bedside invasive procedures. The authors constructed a model from very low-cost and easily accessible materials, such as commercial dummy plus wooden and plastic supports to represent the abdomen, synthetic leather fabric for the skin, upholstered sponge coated with plastic film to represent the abdominal wall and procedure gloves with water mixed with paint to simulate the ascitic fluid and other abdominal structures. One semi-structured form with quantitative and qualitative questions was applied for medical specialists and students in order to evaluate the paracentesis simulator. RESULTS: The paracentesis model has an initial cost of US$22.00 / R$70.00 for 30 simulations and US$16.00 / R$50.00 for every 30 additional simulations. It was tested by eight medical doctors, including clinical medicine, general surgeons and gastroenterologists, and all of them fully agreed that the procedure should be performed on the manikin before in the actual patient, and they all approved the model for undergraduate education. A total of 87 undergraduate medical students (56% male) individually performed the procedure in our simulator. Regarding the steps of the procedure, 80.5% identified the appropriate place for needle puncture and 75.9% proceeded with the Z or traction technique. An amount of 80.5% of the students were able to aspire the fluid and another 80.5% of students correctly performed the bandage at the end of the procedure. All the students fully agreed that simulated paracentesis training should be performed prior to performing the procedure on a real patient. CONCLUSION: The elaboration of a teaching model in paracentesis provided unique experience to authors and participants, allowing a visible correlation of the human anatomy with synthetic materials, deepening knowledge of this basic science and developing creative skills, which enhances clinical practice. There are no data on the use of paracentesis simulation models in Brazilian universities. However, the procedure is quite accomplished in health services and needs to be trained. The model described above was presented as qualified with low cost and easily reproducible.
RESUMO:Objetivo: Desenvolver e aplicar modelo de baixo custo para treinamento de dissecção venosa para acadêmicos de Medicina. Métodos: O modelo foi elaborado com custo fixo de 35 reais (10,5 dólares) e mais 50 centavos a cada reposição, tendo sido aprovados por 6 cirurgiões vinculados ao curso de Medicina da Universidade de Fortaleza e utilizados durante curso teórico prático. Os alunos responderam a um teste pré e pós-atividade, foram avaliados durante a prática através de check list e responderam questionário de percepção sobre o modelo. Resultados: Foi notado crescimento teórico, porém, percebeu-se a necessidade de mais treinamento procedural, o que é viável com nosso modelo de baixo custo. Em relação aos questionários de percepção, 91,95% dos alunos concordaram que os modelos mantinham boa correlação anatômica, 89,96% que o material utilizado é de boa qualidade, 95,40% que o modelo permitiu o aprendizado da dissecção venosa e 96,55% que o modelo pode ser utilizado para ensino do procedimento, números que reafirmam a eficácia e viabilidade do modelo. Conclusões: É possível a criação de modelo realista, de boa qualidade e viável para o ensino, apenas com materiais de baixo custo para treinamento de dissecção venosa.Descritores: Materiais de ensino; Dissecação/educação; Treinamento por simulação; Estudantes de medicina. ABSTRACT: Objective:We aim to develop and apply a low cost model for venous dissection training for medical students. Methods: The model was elaborated with a fixed cost of 35 reais (10,5 dollars) and 50 cents at each replacement, and was approved by 6 surgeons tied to the Medicine course of the Universidade de Fortaleza and used during practical theoretical course. The students answered a pre and post activity test, were evaluated during the practice through check list and answered the perception questionnaire about the model. Results: We noticed a theoretical growth, however, we noticed the need for more procedural training, which is feasible with our low cost model. Regarding the perception questionnaires, 91.95% of the students agreed that the models maintained good anatomical correlation, 89.96% that the material used was of good quality, 95.40% that the model allowed the learning of the venous dissection and 96.55% that the model can be used for teaching the procedure, numbers that reaffirm the effectiveness and feasibility of the model. Conclusions: It is possible to create a realistic model, of good quality and feasible for teaching, only with low cost materials for venous dissection training.
Objective To correlate the patient's clinical data and the Alvarado's Score as predictors of acute appendicitis. Methods This is an observational, descriptive and prospective study performed at a public urgency and emergency hospital in the city of Fortaleza, Ceará, between July and December 2016, with 34 patients undergoing open appendectomy with ages between 18 and 70 years. Statistical analysis was performed using the SPSS program. Results The following statistical correlations were performed: number of days with abdominal pain until the operative event and degree of inflammation according to a macroscopic analysis of the appendix, Alvarado's Score and number of days with abdominal pain until the operative event, Alvarado's Score and degree of inflammation according to a macroscopic analysis of the appendix, number of days with abdominal pain until the operative event, and number of days of hospitalization in the postoperative period, degree of inflammation according to amacroscopic analysis of the appendix, number of days of hospitalization in the postoperative period and Alvarado's Score, and number of days of hospitalization in the postoperative period; the first five correlations were statistically significant ( p < 0.05). Conclusion The use of this Alvarado's Score in health services emerges as a tool for the diagnosis of acute appendicitis.
Background: Three-dimensional videosurgery is already a reality worldwide. The trainee program for this procedure should be done initially and preferably in simulators. Aim: Assemble low-cost simulator for three-dimensional videosurgery training. Methods: The simulator presented here was mounted in two parts, base and glasses. After, several stations can be inserted into the simulator for skills training in videosurgery. Results: It was possible to set up three dimensional (3D) video simulations with low cost. It has proved to be easy to assemble and allows the training surgeon of various video surgical skills. Conclusion: This equipment may be used in undergraduate programs and advanced courses for residents and surgeons. The acrylic box allows the visualization of the task executed by the tutor and even by other experienced students.
Introdução: A reforma curricular nos cursos de Medicina levou a uma redução da carga horária reservada às disciplinas do ciclo básico, como a Anatomia, sendo o monitor indispensável na inserção de melhorias para a disciplina. Objetivo: Avaliar o papel dos monitores no ensino da Anatomia, segundo a perspectiva do aluno. Casuística e Métodos: Estudo observacional, com abordagem quantitativa e qualitativa, desenvolvido com alunos do 4º semestre do curso de medicina da Universidade de Fortaleza, Fortaleza - Ceará / Brasil, com preenchimento de um questionário semiestruturado, padronizado com questões objetivas e subjetivas na escala Likert. Resultados: Constatou-se que a maioria dos alunos frequenta a monitoria presencial em sala de aula e, para estes alunos, esclarecer dúvidas é a principal função do monitor de anatomia. Ademais, o comprometimento com a monitoria é a característica do monitor mais valorizada pelos alunos. Destaca-se ainda que os alunos consideraram que os aplicativos de mensagens instantâneas são ferramentas essenciais para tirar dúvidas e que é mais confortável tirar dúvidas com o monitor do que com o professor. Conclusão: Conclui-se, então, que a vivência da monitoria melhorou o desempenho dos alunos na disciplina de anatomia e o uso de metodologias ativas mostrou-se relevante para a transmissão e a consolidação do conhecimento.
Introduction Mucocele of the appendix is defined as the obstructive dilatation of the vermiform appendix by the abnormal accumulation of mucinous substance in its lumen. Imaging tests may be useful, but they commonly fail to evidence the etiology in question. Regarding the therapeutic approach, there are different options for treatment. Appendectomy was routinely used in simple cystadenomas, with good results. However, in cases of neoplasias, more aggressive resection is necessary, and the therapeutic course of choice is the right hemicolectomy. Case report Patient presented to the surgery outpatient clinic with magnetic resonance imaging presenting an adnexal cyst of about 11.0 × 4.5 cm on the right. The patient had pain in the right iliac fossa for 6 months. Due to the radiological finding and persistence of the clinical picture, videolaparoscopy was performed, and an appendicular mass suggestive of mucocele was identified. A laparoscopic appendectomy was performed, with no signs of mucus extravasation. Histopathological analysis confirmed the diagnosis. Discussion Mucocele is rarely diagnosed effectively in the preoperatively. In this context, imaging tests do rarely evidence such etiology. Given the importance of preoperative diagnosis for the definition of conduct, it is essential that this condition be always taken into account as a diagnostic hypothesis.
Anorectal hemangioma is one of the rarest causes of lower gastrointestinal bleeding, but is often neglected and confused in the differential diagnosis. The clinical examination is a turning point for a correct diagnosis and management of patients, thus avoiding unnecessary procedures. The treatment of choice for this condition is surgical and intraoperative bleeding is the main complication of this therapy. The present case reports a 25-year old patient with a history of bleeding from the age of 13, being diagnosed with anorectal hemangioma, and surgically treated with resection of the affected segment and with wound synthesis by marsupialization, with a good progression postoperatively.
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