Paulo Sérgio Panse Silveira

Internet discussion lists as an educational tool.

Sir, Internet discussion lists (DLs) are widely used in organizations for their facility and flexibility1 and have also been used by certain specialists as a forum in which to share experiences2,3. National health services have used DLs to facilitate the day-to-day work of general practitioners4. However, information about the experience of teaching DL techniques seems to be scanty. A key review article5 states that, among other critical factors, the DL must ‘provide a context and rationale for online communication by helping users to establish a shared purpose’, but emphasizes that there is no consensus about methodological approach and measurement techniques to allow comparison studies. Recent developments in applying statistical methods face the challenge of analysing, in quantitative terms, computer-mediated communications6, but descriptive publications are still necessary to clarify different ways to motivate DL participants in diverse contexts7–9. We have used DLs in teaching the first postgraduate course of the Discipline of Telemedicine of the Faculty of Medicine of the University of São Paulo. The course had three teachers and 14 students. The course was conducted in two parts, each lasting one month. The first month was dedicated to lectures (four hours per week) and practical demonstrations (eight hours per week). The objectives were to teach the theoretical, ethical and practical aspects of telemedicine, and to attain the necessary software skills. The requirement to have email at home was an indirect method of ensuring that the participants had a basic familiarity with the Internet and email. During the practical exercises the students were taught how to construct Web pages and how to search for and select medical Web sites, judging their quality by their educational content. In the second month of the course the students established a DL as a project. At the same time, a textual DL was organized as a tool for the development of their projects. These DLs had to be analysed and criticized by every student and improved by the group. Each participant also gained practical knowledge of the advantages and inconveniences of a DL. The students were instructed to use only the list and to avoid any other form of communication about the projects, such as personal discussions, telephone calls and email exchanges, in order to simulate a geographically dispersed group. A conventional DL was used, based on Matt’s WWWBoard, a script written in Perl that can be obtained through Matt’s Script Archive10 and may be modified according to the situation. It is freeware.

Relationship among Medical Student Resilience, Educational Environment and Quality of Life

Context Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students. Methods We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young’s resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire – short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Results Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements. Conclusions Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.

Web Site for Training Nonmedical Health-Care Workers to Identify Potentially Malignant Skin Lesions and for Teledermatology

The development of a Web site to enable nonmedical health professionals to screen skin potentially malignant skin lesions is described. A nurse assistant and a dermatologist tested the Web site. An electronic clinical form was developed to allow a nurse assistant to send case reports and photographs for remote diagnosis by a dermatologist. The nurse assistant photographed the lesions of 92 patients who presented some kind of dermatological condition. The images were then sent for evaluation by the dermatologist followed by in person examination by the same physician. The diagnoses, which resulted from the examination in person and, in some cases, the biopsy results, were compared with the diagnostic impressions of the nurse assistant and with the diagnostic hypothesis of the dermatologist at a distance. The lesions were classified as either malignant or nonmalignant. Kappa statistics showed a high association between the suspected malignity and nonmalignity of the lesions between the dermatologist (p = 6.01 x 10(-9)) and the nurse assistant and between the diagnosis at distance and in person (p < 1.0 x 10(-14)). The Web site allowed a nurse assistant to screen for potentially malignant skin lesions and, thus, proved to be appropriate for a large-scale test.

Computer-assisted rheological evaluation of microsamples of mucus

Dynamic viscoelasticity measurements are required in many studies on biological fluids and they can be performed by determining the corresponding strain when a sinusoidal shear stress is applied to a sample. In several circumstances the amount of fluid that can be obtained for analysis in physiological conditions does not exceed microliters. In this context, the microrheometer technique is a useful approach to determine the dynamic rheological profile of the samples. However, the manual calculation of the desired parameters is tedious and time-consuming. This paper describes a menu-oriented program in order to facilitate its use by non-experts. The comparison between manual and computer-aided calculations demonstrated that the program reduced the time of measurement, and reduced intra- and interobserver variations. The program was developed on an IBM compatible PC in Microsoft C 5.1, and tested in a blind study to check the advantages in terms of time and reproducibility of the system verified by the concordance of two independent observers (interobserver influence) in two different occasions (intraobserver influence).

Improving data perturbation testing techniques for Web services

The widespread use of service-oriented architectures (SOAs) and Web services in commercial software requires the adoption of development techniques to ensure the quality of Web services. Testing techniques and tools concern quality and play a critical role in accomplishing quality of SOA based systems. Existing techniques and tools for traditional systems are not appropriate to these new systems, making the development of Web services testing techniques and tools required. This article presents new testing techniques to automatically generate a set of test cases and data for Web services. The techniques presented here explore data perturbation of Web services messages upon data types, integrity and consistency. To support these techniques, a tool (GenAutoWS) was developed and applied to real problems.

The development and evaluation of software to verify diagnostic accuracy

This article describes the development and evaluation of software that verifies the accuracy of diagnoses made by nursing students. The software was based on a model that uses fuzzy logic concepts, including PERL, the MySQL database for Internet accessibility, and the NANDA-I 2007-2008 classification system. The software was evaluated in terms of its technical quality and usability through specific instruments. The activity proposed in the software involves four stages in which students establish the relationship values between nursing diagnoses, defining characteristics/risk factors and clinical cases. The relationship values determined by students are compared to those of specialists, generating performance scores for the students. In the evaluation, the software demonstrated satisfactory outcomes regarding the technical quality and, according to the students, helped in their learning and may become an educational tool to teach the process of nursing diagnosis.This article describes the development and evaluation of software that verifies the accuracy of diagnoses made by nursing students. The software was based on a model that uses fuzzy logic concepts, including PERL, the MySQL database for Internet accessibility, and the NANDA-I 2007-2008 classification system. The software was evaluated in terms of its technical quality and usability through specific instruments. The activity proposed in the software involves four stages in which students establish the relationship values between nursing diagnoses, defining characteristics/risk factors and clinical cases. The relationship values determined by students are compared to those of specialists, generating performance scores for the students. In the evaluation, the software demonstrated satisfactory outcomes regarding the technical quality and, according to the students, helped in their learning and may become an educational tool to teach the process of nursing diagnosis.

Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: a nursing approach.

PURPOSE To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I). METHODS A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++(®) Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the experts opinion as a gold standard. In order to compute the Kappas values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different. RESULTS The overestimation of the accordance showed an excellent agreement (kappa=0.92, p<0.0001); and the underestimation provided a moderate agreement (kappa=0.42, p<0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42). CONCLUSIONS The decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view. LIMITATIONS In spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence.

Desenvolvimento e avaliação de um software que verifica a acurácia diagnóstica

This article describes the development and evaluation of software that verifies the accuracy of diagnoses made by nursing students. The software was based on a model that uses fuzzy logic concepts, including PERL, the MySQL database for Internet accessibility, and the NANDA-I 2007-2008 classification system. The software was evaluated in terms of its technical quality and usability through specific instruments. The activity proposed in the software involves four stages in which students establish the relationship values between nursing diagnoses, defining characteristics/risk factors and clinical cases. The relationship values determined by students are compared to those of specialists, generating performance scores for the students. In the evaluation, the software demonstrated satisfactory outcomes regarding the technical quality and, according to the students, helped in their learning and may become an educational tool to teach the process of nursing diagnosis.This article describes the development and evaluation of software that verifies the accuracy of diagnoses made by nursing students. The software was based on a model that uses fuzzy logic concepts, including PERL, the MySQL database for Internet accessibility, and the NANDA-I 2007-2008 classification system. The software was evaluated in terms of its technical quality and usability through specific instruments. The activity proposed in the software involves four stages in which students establish the relationship values between nursing diagnoses, defining characteristics/risk factors and clinical cases. The relationship values determined by students are compared to those of specialists, generating performance scores for the students. In the evaluation, the software demonstrated satisfactory outcomes regarding the technical quality and, according to the students, helped in their learning and may become an educational tool to teach the process of nursing diagnosis.

Evaluation of a multimedia online tool for teaching bronchial hygiene to physical therapy students.

BACKGROUND Advances in information technology have been widely used in teaching health care professionals. The use of multimedia resources may be important for clinical learning and we are not aware of previous reports using such technology in respiratory physical therapy education. OBJECTIVES Our approach was to evaluate a conventional bronchial hygiene techniques (BHTs) course with an interactive online environment, including multimedia resources. METHODS Previous developed audiovisual support material comprised: physiology, physiopathology and BHTs, accessible to students through the Internet in conjunction with BHTs classes. Two groups of students were compared and both attended regular classes: the on-line group (n=8) received access to online resources, while the control group (n=8) received conventional written material. Students performance was evaluated before and after the course. RESULTS A preliminary test (score 0 to 10) was applied before the beginning of the course, showing that the initial knowledge of both groups was comparable [online, 6.75 (SD=0.88) vs. control, 6.125 (SD=1.35); p>0.05]. Two weeks after the end of the course, a second test showed that the online group performed significantly better than the control group [respectively, 7.75 (SD=1.28) vs. 5.93 (SD=0.72); p>0.05]. CONCLUSIONS The use of a multimedia online resource had a positive impact on students learning in respiratory therapy field in which instrumental and manual resources are often used and can be explored using this technology.

Aging is not senescence: a short computer demonstration and implications for medical practice

INTRODUCTION: The discussion regarding the evolution of aging is almost as old as Darwinian Evolution Theory, but to date, it has remained one of biology’s unresolved problems. One issue is how to reconcile natural selection, which is understood as a process that purges deleterious characteristics, with senescence, which seems to offer no advantages to the individual. METHOD: A computer simulation that illustrates an evolutionary mechanism for the development of senescence in populations is presented. DISCUSSION: In this article, we debate that two popular explanations for the existence of senescence, namely, (1) the removal of elders for the benefit of the species and (2) the progressive deterioration of the organic machine due to continuous use, are not correct. While human populations continue to age, it is important that the physician understands that senescence, here defined as the progressive impairment of an organism, does not necessarily accompany aging, which we here define as the mere passage of time. As such, we argue that certain processes that were originally assumed to be part of aging should have their status changed because they are actually diseases. Physicians often encounter situations that depend on a better understanding of what limitations senescence imposes on most living species. The concepts of aging (the unavoidable passage of time), senescence (progressive physiologic impairment), and senility (the pathological development of diseases), are discussed.