Amanda Helena Rodrigues Franco

Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures

OBJECTIVES Propofol is a short-acting, hypnotic agent that is increasingly being used for gastrointestinal endoscopic sedation. There are concerns about the use of propofol by non anesthesiologists due to its potential for respiratory and cardiovascular depression. This report describes our experience concerning effectiveness and safety of propofol administered in endoscopic procedures by the endoscopist and the assistant nurse. METHODS In this prospective study, a total of 102 consecutive endoscopies (60 colonoscopies and 42 upper endoscopies) performed under sedation with propofol were included. In 27 (26.47%) endoscopies propofol was administered alone and in 75 endoscopies (73.53%) it was combined with benzodiazepines and/or opioids. Seventy-six (74.51%) endoscopies were performed in patients under 65 years of age and 26 (25.49%) in patients over 65 years of age. Ninety-one (89.22%) endoscopies were performed in patients with low surgical risk (ASA I-II) and 11 (10.78%) in patients with high surgical risk. The medication was administered by the endoscopist that performed the procedure and the assistant nurse. RESULTS The mean dose of propofol used was 72.14 mg for gastroscopies and 71.33 for colonoscopies (p = 0.92). The mean dose of propofol when infused alone was 84.81 mg whereas in combination with benzodiazepines/opioids was 66.93 mg (p = 0.06). The doses of propofol required were lower for those colonoscopies in which midazolam and/or meperidine was combined and in patients over 65 years of age (p = 0.006 y p = 0.001, respectively). Eleven (10.8%) minor complications were reported, and managed by the own endoscopist. Patients had no memories of the procedure. The tolerance rated by the endoscopist was excellent-good, fair, bad-very bad in 83, 5 and 12% of the gastroscopies and in 79, 8 and 13% of the colonoscopies respectively. Nevertheless bad tolerance did not hinder the completion of the procedure in any case. CONCLUSIONS The administration of propofol by the endoscopist and the assistant nurse, is an effective and safe method of sedation in patients of low and high-risk as well as in elderly patients. The doses of propofol required for an adequate sedation were lower in patients over 65 years of age and for colonoscopies in which medication was combined.

Real-World Outcomes and Critical Thinking: Differential Analysis by Academic Major and Gender

The Real-World Outcomes is an inventory that measures everyday problematic behaviors that represent decisions where critical thinking is presumably absent; assessing the negative outcomes of poor daily decisions helps to infer the degree of critical thinking that mediates everyday reasoning. In the present paper, we describe the process of translation and cultural adaptation of this inventory to Portuguese. We present evidence of its administration to 259 college students concerning reliability, and differences based on academic major and gender. No statistically significant differences were found, either due to academic major or gender. Results suggest the value of this instrument to assessing daily decision making and life outcomes, and also, to estimate the quality of critical thinking in everyday life.O Real-World Outcomes e um inventario que avalia comportamentos problematicos do dia-a-dia que representam decisoes onde se presume que o pensamento critico esta ausente; ao avaliar os resultados negativos de decisoes quotidianas pobres, permite inferir o grau de pensamento critico que medeia o raciocinio no quotidiano. Neste artigo, descreve-se o processo de traducao e adaptacao cultural deste inventario para a lingua Portuguesa. Apresentam-se dados da sua administracao a 259 estudantes universitarios relativos a consistencia interna, e as diferencas de acordo com a area academica e genero. Nao foram encontradas diferencas estatisticamente significativas, nem decorrentes da area academica, nem do genero. Os resultados sugerem a relevância deste instrumento para avaliar a tomada de decisao no dia-a-dia e seu impacto na vida dos sujeitos, e tambem, para estimar a qualidade do pensamento critico usado na vida quotidiana.

Assessment of undergraduates’ real-world outcomes of critical thinking in everyday situations

Critical thinking is a kind of “good” thinking that integrates a set of cognitive skills and dispositions to use those skills with knowledge to increase the chances of success in academic settings, job market, and daily life. The impact of critical thinking on life events, in face of everyday decisions and challenges, is still unclear, and further research is needed. In this exploratory study, a sample of 230 first-year students of a Bachelor’s Degree or a Master’s Degree in Portugal completed an experimental Portuguese version of the Real-World Outcomes, a self-report inventory measuring everyday negative life events that are mediated by a lack of critical thinking. Based on exploratory factor analysis results and theoretical premises, changes were made to the Portuguese version of the inventory that was administered, and items were aggregated into six dimensions, creating a new version that is more familiar to Portuguese young adults in college. This original proposal of the inventory presents six types of negative life events resulting from a lack of critical thinking: health neglect, mismanagement, slackness, poor impulse control, academic negligence, and rashness. Both limitations and future potentialities of this version are presented.

What Do "Ode to Joy," the Nobel Peace Prize, Umbrellas and Cartoons Have in Common? Why Critical Thinking Matters and How Higher Education Moulds.

Critical thinking is the kind of ‘good’ thinking used in everyday life to increase the chances of success. A critical thinker combines skill and will when working the odds in one’s advantage. Nevertheless, thinking is very often far from rational. Since people are built to believe, since living is all about choosing and since education liberates, critical thinking is essential: in higher education, in the job market and in everyday life. Yet, it needs explicit instruction and inclusion in the curriculum. This article, grounded on current literature and oriented towards the future, addresses the higher mission of higher education. Higher education must aim to prepare individuals to become active citizens, who address life as a process of meaningful lifelong learning and who are devoted to non-stop regulation of thinking and behaviour, which are guided by ethics and evidence for personal and common prosperity and, more important, freedom.

Real-World Outcomes y Pensamiento Crítico: Análisis Diferencial por Área y Género

The Real-World Outcomes is an inventory that measures everyday problematic behaviors that represent decisions where critical thinking is presumably absent; assessing the negative outcomes of poor daily decisions helps to infer the degree of critical thinking that mediates everyday reasoning. In the present paper, we describe the process of translation and cultural adaptation of this inventory to Portuguese. We present evidence of its administration to 259 college students concerning reliability, and differences based on academic major and gender. No statistically significant differences were found, either due to academic major or gender. Results suggest the value of this instrument to assessing daily decision making and life outcomes, and also, to estimate the quality of critical thinking in everyday life.O Real-World Outcomes e um inventario que avalia comportamentos problematicos do dia-a-dia que representam decisoes onde se presume que o pensamento critico esta ausente; ao avaliar os resultados negativos de decisoes quotidianas pobres, permite inferir o grau de pensamento critico que medeia o raciocinio no quotidiano. Neste artigo, descreve-se o processo de traducao e adaptacao cultural deste inventario para a lingua Portuguesa. Apresentam-se dados da sua administracao a 259 estudantes universitarios relativos a consistencia interna, e as diferencas de acordo com a area academica e genero. Nao foram encontradas diferencas estatisticamente significativas, nem decorrentes da area academica, nem do genero. Os resultados sugerem a relevância deste instrumento para avaliar a tomada de decisao no dia-a-dia e seu impacto na vida dos sujeitos, e tambem, para estimar a qualidade do pensamento critico usado na vida quotidiana.

Real-World Outcomes e Pensamento Crítico: Análise Diferencial por Área e Género

The Real-World Outcomes is an inventory that measures everyday problematic behaviors that represent decisions where critical thinking is presumably absent; assessing the negative outcomes of poor daily decisions helps to infer the degree of critical thinking that mediates everyday reasoning. In the present paper, we describe the process of translation and cultural adaptation of this inventory to Portuguese. We present evidence of its administration to 259 college students concerning reliability, and differences based on academic major and gender. No statistically significant differences were found, either due to academic major or gender. Results suggest the value of this instrument to assessing daily decision making and life outcomes, and also, to estimate the quality of critical thinking in everyday life.O Real-World Outcomes e um inventario que avalia comportamentos problematicos do dia-a-dia que representam decisoes onde se presume que o pensamento critico esta ausente; ao avaliar os resultados negativos de decisoes quotidianas pobres, permite inferir o grau de pensamento critico que medeia o raciocinio no quotidiano. Neste artigo, descreve-se o processo de traducao e adaptacao cultural deste inventario para a lingua Portuguesa. Apresentam-se dados da sua administracao a 259 estudantes universitarios relativos a consistencia interna, e as diferencas de acordo com a area academica e genero. Nao foram encontradas diferencas estatisticamente significativas, nem decorrentes da area academica, nem do genero. Os resultados sugerem a relevância deste instrumento para avaliar a tomada de decisao no dia-a-dia e seu impacto na vida dos sujeitos, e tambem, para estimar a qualidade do pensamento critico usado na vida quotidiana.