OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model. METHODS Two human cadaver heads and 30 human placentas were used. Twelve neurosurgeons participated in the concurrent validity part of this study, each operating on 1 human cadaver head aneurysm model and 1 human placenta model. Simulators were evaluated regarding their ability to simulate different surgical steps encountered during real surgery. The time to complete the entire aneurysm task in each simulator was analyzed. The predictive validity component of the study involved 9 neurosurgical residents divided into 3 groups to perform simulation exercises, each lasting 6 weeks. The training for the 3 groups consisted of educational video only (3 residents), human cadaver only (3 residents), and human placenta only (3 residents). All residents had equivalent microsurgical experience with superficial brain tumor surgery. After completing their practice training, residents in each of the 3 simulation groups performed surgery for an unruptured middle cerebral artery (MCA) aneurysm, and their performance was assessed by an experienced vascular neurosurgeon who watched the operative videos. RESULTS All human cadaver heads and human placentas were suitable to simulate brain aneurysm surgery. In the concurrent validity portion of the experiment, the placenta model required a longer time (p < 0.001) than cadavers to complete the task. The placenta model was considered more effective than the cadaver model in simulating sylvian fissure splitting, bipolar coagulation of oozing microvessels, and aneurysm neck and dome dissection. Both models were equally effective in simulating neck aneurysm clipping, while the cadaver model was considered superior for simulation of intraoperative rupture and for reproduction of real anatomy during simulation. In the predictive validity portion of the experiment, residents were evaluated for 4 tasks: sylvian fissure dissection, microvessel bipolar coagulation, aneurysm dissection, and aneurysm clipping. Residents trained in the human placenta simulator consistently had the highest overall performance scores when compared with those who had trained in the cadaver model and those who had simply watched operative videos (p < 0.001). CONCLUSIONS The human placenta biological simulator provides excellent simulation for some critical tasks of aneurysm surgery such as splitting of the sylvian fissure, dissection of the aneurysm neck and d...

Introdução: O trauma raquimedular é um fator de risco para o desenvolvimento de úlcera por pressão, em decorrência das várias alterações sensitivas e motoras que o acompanham. A estimulação elétrica de alta voltagem é um meio de administrar estímulos elétricos para promover a cicatrização de feridas. O uso dessa terapia pode promover o aumento do fluxo sanguíneo, fagocitose, melhora da oxigenação, redução do edema, atração e estimulação de fibroblastos e células epiteliais. Objetivo: Avaliar a eficácia da estimulação elétrica de alta voltagem em um participante do gênero masculino, portador de úlcera por pressão sacral. Métodos: Foi aplicada sobre a úlcera a estimulação elétrica; um eletrodo de borracha siliconizada com gaze estéril embebida em soro fisiológico foi posicionado sobre a lesão. A corrente elétrica foi realizada por um tempo de 45 minutos/sessão, três vezes por semana, durante quatro semanas, totalizando doze sessões. Resultados: Os resultados mostraram uma porcentagem de 17% de redução na área, além de um melhor aspecto da ferida, sugerindo maior número de sessões para resultados mais satisfatórios. Conclusão: Os parâmetros utilizados no presente estudo mostraram-se eficazes em aprimorar a cicatrização da lesão do paciente, porém insuficientes para o fechamento completo da ferida.Palavras-chave: úlcera por pressão, estimulação elétrica de alta voltagem, cicatrização de feridas.

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Objective: To investigate the validity and test–retest reliability of mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra) to estimate the number of steps in individuals after chronic stroke and to compare whether the measurement of the number of steps is affected by their location on the body (paretic and non-paretic side). Design: Observational study with repeated measures. Setting: University laboratory. Subjects: Fifty-five community-dwelling individuals with chronic stroke. Intervention: Not applicable. Main measures: The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra), and compared against criterion-standard measure during the Two-Minute Walk Test using habitual speed. Results: Our sample was 54.5% men, mean age of 62.5 years (SD 14.9) with a chronicity after stroke of 66.8 months (SD 55.9). There was a statistically significant association between the actual number of steps and those estimated by the Google Fit, STEPZ Iphone and Android applications, Pacer iphone and Android, and Fitbit Ultra (0.30 ⩽  r ⩾ 0.80). The Pacer iphone application demonstrated the highest reliability coefficient (ICC(2,1) = 0.80; P < 0.001). There were no statistically significant differences in device measurements that depended on body location. Conclusions: mHealth devices (Pacer–iphone, Fitbit Ultra, Google Fit, and Pacer–Android) are valid and reliable for step counting in chronic stroke survivors. Body location (paretic or non-paretic side) does not affect validity or reliability of the step count metric.

Objective: Describe the prehospital pediatric assistance conducted by the Mobile Emergency Care Service (SAMU) in the town of Feira de Santana, Bahia, Brazil, in 2009. Method: This is a quantitative, retrospective, and descriptive research, based on the records of pediatric treatments conducted by SAMU in the town of Feira de Santana. Results: One identified 372 treatments; 43.5% for children from 5 to 10 years; 57.1% of occurrences took place at home; falls (28.7%) and running over cases (22.9%) were the most usual external causes; the most prevalent clinical causes were respiratory problems (40.0%) and convulsive crises (27.9%). Conclusion: The study allowed knowing the reality of prehospital assistance for children in the town, and it can contribute to public policies aimed at this clientele; besides, it collaborates to the scientific production related to the prehospital child assistance, a theme poorly explored among this population. Descriptors: Emergency medicine, Emergency nursing, Child health. RESUMO Objetivo: Descrever o atendimento pré-hospitalar pediátrico realizado pelo Serviço de Atendimento Móvel de Urgência (Samu) no município de Feira de Santana-BA, em 2009. Método: Trata-se de pesquisa quantitativa, retrospectiva e descritiva, baseada nos registros dos atendimentos pediátricos realizados pelo Samu no município de Feira de Santana. Resultados: Foram identificados 372 atendimentos; 43,5% a crianças de 5 a 10 anos; 57,1% das ocorrências foram no domicílio; quedas (28,7%) e atropelamentos (22,9%) foram as causas externas mais comuns; as causas clínicas mais prevalentes foram agravos respiratórios (40,0%) e crises convulsivas (27,9%). Conclusão: O estudo permitiu conhecer a realidade da assistência pré-hospitalar à criança no município, podendo contribuir com políticas públicas voltadas a essa clientela; além disso, colabora com a produção científica relacionada ao atendimento pré-hospitalar infantil, tema pouco explorado nessa população. Descritores: Medicina de emergência, Enfermagem de emergência, Saúde da criança. RESUMEN Objetivo: Describir el atendimiento pre-hospitalario pediátrico realizado por el Servicio de Atención Móvil de Urgencia (Samu) en el municipio de Feira de Santana, Bahia, Brasil, en 2009. Método: Esta es una investigación cuantitativa, retrospectiva y descriptiva, basada en los registros de los atendimientos pediátricos realizados por el Samu en el municipio de Feira de Santana. Resultados: Fueron identificados 372 atendimientos; 43,5% a niños de 5 a 10 años; 57,1% de las ocurrencias fueron en el domicilio; caídas (28,7%) y atropellos (22,9%) fueron las causas externas más comunes; las causas clínicas más prevalentes fueron problemas respiratorios (40,0%) y crisis convulsivas (27,9%). Conclusión: El estudio permitió conocer la realidad de la asistencia pre-hospitalaria al niño en el municipio, pudiendo contribuir con políticas públicas dirigidas a esa clientela; además, colabora con la producción científica relacionada con el atendimiento prehospitalario infantil, tema poco exp...

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OBJECTIVESurgical performance evaluation was first described with the OSATS (Objective Structured Assessment of Technical Skills) and modified for aneurysm microsurgery simulation with the OSAACS (Objective Structured Assessment of Aneurysm Clipping Skills). These methods rely on the subjective opinions of evaluators, however, and there is a lack of objective evaluation for proficiency in the microsurgical treatment of brain aneurysms. The authors present a new instrument, the Skill Assessment in Microsurgery for Brain Aneurysms (SAMBA) scale, which can be used similarly in a simulation model and in the treatment of unruptured middle cerebral artery (MCA) aneurysms to predict surgical performance; the authors also report on its validation.METHODSThe SAMBA scale was created by consensus among 5 vascular neurosurgeons from 2 different neurosurgical departments. SAMBA results were analyzed using descriptive statistics, Cronbach’s alpha indexes, and multivariate ANOVA analyses (p < 0.05).RESULTSExpert, intermediate-level, and novice surgeons scored, respectively, an average of 33.9, 27.1, and 16.4 points in the real surgery and 33.3, 27.3, and 19.4 points in the simulation. The SAMBA interrater reliability index was 0.995 for the real surgery and 0.996 for the simulated surgery; the intrarater reliability was 0.983 (Cronbach’s alpha). In both the simulation and the real surgery settings, the average scores achieved by members of each group (expert, intermediate level, and novice) were significantly different (p < 0.001). Scores among novice surgeons were more diverse (coefficient of variation = 12.4).CONCLUSIONSPredictive validation of the placenta brain aneurysm model has been previously reported, but the SAMBA scale adds an objective scoring system to verify microsurgical ability in this complex operation, stratifying proficiency by points. The SAMBA scale can be used as an interface between learning and practicing, as it can be applied in a safe and controlled environment, such as is provided by a placenta model, with similar results obtained in real surgery, predicting real surgical performance.

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