Introducción: Para ejercer la colonoscopía en un país latinoamericano es requisito certificar la adquisición de la competenciaespecífica, pero no hay consenso respecto a los criterios que la definen. La falta de formación en competencias en endoscopía digestiva, se asocia a mayor riesgo de error diagnóstico y terapéutico; diagnóstico tardío del cáncer, mayor riesgo de complicaciones y la realización de procedimientos incompletos con consecuencias negativas para los pacientes. Objetivo: Establecer los criterios de desempeño de la competencia específica requerida por un especialista para ejercer la colonoscopía, con el fin de impactar con mejores resultados en la calidad de la salud. Materiales y métodos: Estudio cualitativo de consenso de expertos. Con entrevistas personales semiestructuradas se documenta la información para realizar los cuestionarios que se aplican en rondas sucesivas hasta alcanzar consenso mayor al 70% con la participación de más del 80% de los expertos, utilizando el método Delphi. Resultados: Se identifican los criterios de desempeño, que determinan la competencia específica requerida para ejercer con calidad y seguridad la colonoscopía. Con hallazgos significativos por el alto porcentaje de acuerdo, se presentan agrupados en 4 categorías: general, antes, durante y posterior al procedimiento. Dentro de los criterios más importantes que alcanzaron un acuerdo del 100%, están los relacionados con habilidades cognitivas, motoras e integrativas; calidad, seguridad, tamización, técnicas diagnósticas y terapéuticas de este procedimiento. Conclusión: Los criterios estandarizados por consenso, constituyen una herramienta muy valiosa en los países latinoamericanos para la formación yevaluación de competencias.
The present work deals with the development and evaluation of an Intelligent Tutoring System (ITS) used to aid in the learning of Propositional Logical Equivalence in the Licenciatura em Computação of the Setor Palotina of UFPR.In the development of the ITS, we used Web Development and Artificial Intelligence (IA) techniques, such as Bootstrap and Fuzzy Logic. Its use was based on the solution of challenges by the student, and with each challenge the system reports feedback and accompanies him in the progress of his learning. The software was submitted to experiments, in order to validate it as an educational tool. We had results that show an improvement in students' learning in the Logic discipline of our institution.Resumo. O presente trabalho aborda o desenvolvimento e a avaliação de um Sistema Tutor Inteligente (STI) utilizado para auxiliar na aprendizagem de Equivalência Lógica Proposicional no Curso de Licenciatura em Computação do Setor Palotina da UFPR. Na criação do STI foram utilizadas técnicas de Desenvolvimento Web e de Inteligência Artificial (IA), tais como Bootstrap e Lógica Fuzzy. Sua utilização foi baseada na solução de desafios pelo aluno sendo que, a cada desafio, o sistema lhe reporta um feedback e o acompanha no progresso de sua aprendizagem. O software foi submetido a experimentos, com o intuito de validá-lo enquanto ferramenta educacional. Como resultado obtivemos uma melhora na aprendizagem dos alunos da disciplina de Lógica de nossa instituição.
OBJECTIVE To evaluate the cost-effectiveness of tofacitinib versus other treatment options currently available in Colombia for the management of adult patients with moderate-to-severe ulcerative colitis in naïve to biologics (first line) and exposed to biologics (second line). METHODS A Markov model was constructed with 8 weeks cycles. It simulates a cohort of patients with moderate-to-severe ulcerative colitis from a payer perspective in a 5-year horizon. The health states include remission, treatment response (without remission), active UC, and colectomy. The transition probabilities for the induction and maintenance phase were obtained from a network meta-analysis. Effectiveness was measured from quality-adjusted life-year (QALY) and the utilities were obtained from the literature. Unit costs were derived from official national sources, and these were expressed in US dollars 2021 at the average exchange rate of $3 693 COP/US. Probabilistic and deterministic sensitivity analyses were conducted. The threshold was defined as one gross domestic product ($5 391) per capita. RESULTS For first line, the incremental cost-effectiveness ratio (ICER) per QALY was for tofacitinib $2 611 and for infliximab $7 652 compared to adalimumab. Sensitivity analysis showed that tofacitinib is shown as cost-effective in 52% of the iterations, followed by adalimumab 25% and infliximab 23% patients. Meanwhile, adalimumab was $27 527 compared to tofacitinib in second line. Tofacitinib was cost-effective 72% of the iterations, followed by adalimumab 28% in the sensitivity analysis. Infliximab and golimumab were not included due to data limitation in network metanalysis in second line. For both lines vedolizumab was not a cost-effective alternative under the threshold assessed. CONCLUSION The analysis suggests that, in Colombia, the treatment with tofacitinib for moderate-to-severe UC patients is a cost-effective option in both lines, compare with other treatment options available.
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