The objective of this study is to report the use of a non-invasive sensor to assess intracranial compliance (ICC) in patients complaining of migraine. This case report presents a 34-year-old, female patient that was treated for idiopathic intracranial hypertension (IIH) by placing a non-adjustable lumboperitoneal shunt. After one year, she presented with headache and signs of overdrainage. Non-invasive monitoring of ICC was done, suggesting a reduction in the ICC, but no change in the opening pressure of the valve. A diagnosis of migraine was made, with improvement after brain monitoring, leading treatment without any new surgical intervention. With this case, we conclude that the use of non-invasive sensor helped the medical team to understand the information obtained by the ICP curve in the office, and in the management of patients with headache complaints, supporting clinical decision making, improving the quality of care, correlated with underlying diseases and procedural and patient safety.
Introduction: An effective simulation program allows both the acquisition of surgical skills on the simulated model and the transfer of these skills to a surgical scenario. We designed a forefoot osteotomy training program and sought to determine the transferability to a cadaveric surgical scenario. Methods: Eleven orthopedic residents and 2 foot and ankle surgeons were included. A foot simulator was used. All residents were instructed on the surgical techniques of Chevron, Akin, and triple Weil osteotomies. Eight junior residents (trainees) were enrolled in a supervised simulation program. Baseline assessment was performed on the simulator with the Objective Structured Assessment of Technical Skills (OSATS) and the Imperial College Surgical Assessment Device (ICSAD). After baseline, trainees completed a training program and had a final evaluation of proficiency on the simulator and on cadaveric specimens. Three senior residents with no simulated training (controls) and experts were assessed for comparison. Results: All trainees improved from a baseline OSATS score of 11 points (9-20) to a final score of 35 points (33)(34)(35) in the simulator and 34 points (32-34) in the cadaveric specimen (P < 0.01). Compared with baseline, the ICSAD results improved in path length (391 [205-544] to 131 [73-278] meters, P < 0.01) and number of movements (2756 [1258-3338] to 992 , P < 0.01). The final OSATS and ICSAD scores did not differ from experts (P = 0.1) and were significantly different from untrained residents (P = 0.02). Conclusions: Simulated training of Chevron, Akin, and triple Weil osteotomies in orthopedic residents improved procedural proficiency, enabling successful skill transfer to a surgical scenario in cadavers.
Resumo: A análise da percepção ambiental gera diagnósticos eficientes na definição de diretrizes para intervenções urbanas no campo do planejamento urbano e regional. No planejamento urbano se faz necessário levantamentos e análises considerando de maneira integrada, as características físicas, ambientais, jurídicas e sociais da paisagem a ser requalificada. Este artigo faz uma análise e interpretação da paisagem da orla do porto geral da cidade de Corumbá, do início da Prainha Vermelha à área da Cacimba da Saúde com a finalidade de auxiliar na elaboração de diretrizes para o planejamento dos espaços degradados, mal utilizados e abandonados. O objetivo foi possibilitar o desenvolvimento de projetos de requalificação urbana, arquitetura e paisagismo coerentes com as necessidades e potencialidades da região. Os levantamentos apontaram sérios problemas urbanos como degradação do espaço físico e ambiental, uso irregular da orla, esgotamento sanitário deficitário, dentre outros. São apresentadas diretrizes para requalificação dos espaços e projetos de intervenção. Palavras-Chave: Intervenção Urbana, Turismo, Paisagem, Percepção ambiental.Resumen: El análisis de la percepción ambiental genera diagnósticos eficientes en la definición de pautas para intervenciones urbanas en el campo de la planificación urbana y regional. En la planificación urbana, las encuestas y análisis son necesarios teniendo en cuenta, de manera integrada, las características físicas, ambientales, legales y sociales del paisaje a recalificar. Este artículo hace un análisis e interpretación del paisaje del puerto general de Corumbá desde el comienzo de Prainha Vermelha hasta el área de Cacimba da Saúde con el propósito de ayudar en la elaboración de pautas para la planificación de espacios degradados, mal utilizados y abandonados. El objetivo fue permitir el desarrollo de proyectos de recalificación urbana. arquitectura y
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