sábado, 31 de março de 2018

Inovação em Neurocirurgia







Médicos da USP usam smartphones para cirurgias no cérebro

Em artigo científico, pesquisadores demonstraram a integração entre celulares e endoscópios em 42 neurocirurgias realizadas no Hospital das Clínicas; recurso facilita manipulação do equipamento, tornando procedimento mais intuitivo e seguro

Fábio de Castro

Uma equipe de médicos brasileiros demonstrou que smartphones podem facilitar e baratear as neurocirurgias. Os pesquisadores, do Hospital das Clínicas (HC) da Universidade de São Paulo (USP) adaptaram smartphones ao endoscópio - o instrumento utilizado para observar o interior do organismo. O novo recurso foi descrito em um artigo publicado nesta terça-feira, 13 na principal revista científica internacional de neurocirurgia, Journal of Neurosurgery.
A neuroendoscopia é um procedimento neurocirúrgico pouco invasivo utilizado em alguns casos para corrigir hidrocefalia, remover tumores, tratar doenças vasculares e outros problemas no cérebro. No novo estudo, os cientistas demonstraram a aplicação do novo recurso em neurocirurgias realizadas em 42 pacientes no HC.
De acordo com o autor principal do estudo, Maurício Mandel, do HC-USP e do Hospital Israelita Albert Einstein, a ideia inicial era apenas baratear os procedimentos de neuroendoscopia, mas o recurso acabou mostrando diversas vantagens em relação aos métodos convencionais.  
Segundo ele, um sistema de neuroendoscopia custa de R$ 200 mil a R$ 300 mil. A nova opção os custos são reduzidos ao preço de um iPhone - a marca de smartphone utilizada no estudo - e do adaptador que integra o endoscópio ao celular, que custa cerca de R$ 1 mil. 
Parte inferior do form"Com essa redução de custos, é muito provável que esse recurso possa ser utilizado no SUS, em várias escalas, com aplicação em outros tipos de cirurgia. Mas ao desenvolver o novo sistema, descobrimos que o trabalho do cirurgião também se torna mais seguro e mais simples", disse Mandel ao Estado



 
"Com o smartphone, o cirurgião não precisa virar a cabeça para olhar o monitor. Em vez disso, ele utiliza o celular como uma tela de alta definição bem na frente do endoscópio", disse Maurício Mandel, um dos autores do artigo publicado na revista Journal of Neurosurgery. Foto: Journal of Neurosurgery / Maurício Mandel


De acordo com Mandel, com o método convencional, o cirurgião introduz um neuroendoscópio em uma pequena incisão no crânio, no nariz ou no céu da boca do paciente. O neuroendoscópio inclui uma fonte de luz para iluminar o campo de cirurgia, lentes de aumento e uma câmera, que envia as imagens a um monitor na sala de operação, além de canais para inserção de instrumentos cirúrgicos.
"Com o smartphone, o cirurgião não precisa virar a cabeça para olhar o monitor. Em vez disso, ele utiliza o celular como uma tela de alta definição bem na frente do endoscópio. Com isso, ganhamos a enorme vantagem de podermos olhar para o campo cirúrgico enquanto trabalhamos. Isso facilita a manobra do equipamento, porque a tela se move junto com o endoscópio, tornando o procedimento muito mais intuitivo e seguro", explicou Mandel. 
Além disso, segundo Mandel, o método permite gravar e transmitir em tempo real - por wi-fi ou bluetooth - todas as imagens da neurocirurgia. Elas podem ser enviadas, por exemplo, a um monitor onde outros cirurgiões podem acompanhar o procedimento. "Com o celular acoplado, temos a possibilidade de transmitir a cirurgia ao vivo para um colega em qualquer parte do mundo."
"O recurso abre portas para algumas possibilidades que nem imaginamos ainda. Às vezes, na medicina, há casos difíceis ou raros que mesmo um cirurgião muito experiente pode nunca ter encontrado em sua carreira. Se temos a oportunidade de compartilhar a cirurgia ao vivo com um colega mais experiente, isso pode ser muito bom para os pacientes", disse Mandel.
Recurso pedagógico. Segundo Mandel, o estudo descreve o uso do smartphone adaptado ao neuroendoscópio em cirurgias realizadas em 42 pacientes, mas a equipe do HC já utilizou o recurso em mais de 150 casos - incluindo tratamento para hidrocefalia, aneurismas e a retirada de hematomas provocados por trauma. De acordo com ele, como todos os passos da cirurgia são gravados, o conteúdo está sendo utilizado também para fins pedagógicos.
"Mostramos também no estudo que a integração de smartphone e neuroendoscópio proporcionou que nossos residentes aprendessem muito mais rápido a realizar neurocirurgias." 
O acoplador utilizado pelos pesquisadores para integrar smartphone e neuroendoscópio já existia no mercado e era utilizado especialmente para facilitar a entubação de pacientes. "Tivemos a ideia de utilizar o acoplador para a neurocirurgia. Foi preciso fazer algumas adaptações", contou Mandel.
Durante as cirurgias descritas no estudo, os pesquisadores utilizaram iPhones modelos 4, 5 e 6, combinados com diversos tipos de neuroendoscópios. As imagens foram enviadas por wi-fi diretamente a um monitor de vídeo que permaneceu na sala de operação, para o caso de ser necessário utilizar o procedimento convencional. Mas não foi preciso recorrer ao monitor externo nenhuma vez. 
Todas as cirurgias foram bem sucedidas e não houve nenhum tipo de complicação relacionada ao uso do smartphone, de acordo com o estudo. Uma das conclusões do artigo é que o baixo custo do novo recurso permite sua utilização em áreas onde a infraestrutura médica não é suficiente para a aquisição e manutenção de equipamentos caros.
Além de Mandel, os demais autores do artigo são  Carlo Emanuel Petito e Rafael Tutihashi, também do HC-USP e do Hospital Albert Einstein, Wellingson Paiva, Fernando Gomes Pinto, Almir Ferreira de Andrade, Manoel Jacobsen Teixeira e Eberval Gadelha Figueiredo - todos do HC-USP - e Suzana Abramovicz Mandel, do Hospital Albert Einstein.

 




terça-feira, 27 de março de 2018

Educação Interprofissional





Esse é o quarto ano em que a proposta está sendo colocada em prática
 
Ana Paula Machado Velho 

Cerca de 400 alunos dos cursos da saúde, da Universidade Estadual de Maringá (UEM), iniciaram sua jornada pela formação interdisciplinar, foco dos currículos da instituição na área, na primeira aula da matéria Atenção em Saúde. As atividades tiveram início no auditório do Dacese, no câmpus de Maringá da UEM, na quinta-feira (22).




Segundo o coordenador pedagógico da disciplina e supervisor da enfermaria de pediatria do Hospital Universitário Regional de Maringá (HUM), Edson R. Arpini Miguel, a disciplina Atenção em Saúde leva os alunos a vivenciar, desde o primeiro ano, o ambiente das Unidades Básicas de Saúde (UBS). São formados grupos mistos de 10 alunos cada um, que são acompanhados por professores formados para trabalhar com grupos interdisciplinares e por preceptores dos serviços. A proposta tem, ainda, o apoio da Secretaria Municipal de Saúde, que a entende como uma estratégia que pode criar novas interfaces entre a universidade e os serviços de saúde, explicou Arpini.

O professor, que organiza a iniciativa junto com a coordenadora da disciplina, a professora da enfermagem Ana Paula Oliva, acrescentou que a metodologia utilizada nas aulas é centrada no estudante, com problematização da prática. “Na primeira aula da disciplina, os professores usaram a Team Based Learning, uma metodologia que traz problemas para serem pensados e resolvidos em conjunto, pelos estudantes, bem diferente das estratégias normalmente usadas em sala de aula. É uma forma de inserir o aluno na realidade com várias aproximações e complexidade progressiva, visando à prática inter profissional futura”, esclareceu o pediatra do HUM.





Os cursos envolvidos na disciplina são: Medicina, Enfermagem, Odontologia, Educação Física, Biomedicina, Farmácia e Psicologia, da área de Humanas.




domingo, 25 de março de 2018

US Med Schools Ranking



U.S.News ranks 'Best Medical Schools 2019'

By Alyssa Rege 

U.S. News' rankings for the top medical schools for research and primary care are part of the publication's annual "2019 Best Graduate Schools" lists, which recognize the top institutions for several graduate programs, including business, education, law, engineering, nursing and medicine. The publication also published new rankings this year for graduate programs in other popular disciplines, including biological sciences, chemistry, public affairs, social work and criminology.
Researchers noted this year's list decreased emphasis on medical schools' perceived reputation by 10 percentage points, and added four new factors to measure the amount in nonfederal and non-National Institutes of Health research grant funding institutions received.
Here are the top 10 medical schools for research, including ties, as ranked by U.S. News.
1. Harvard Medical School
2. The Johns Hopkins School of Medicine (Baltimore)
3. NYU School of Medicine (New York City)
3. Stanford (Calif.) University School of Medicine
5. UC San Francisco School of Medicine
6. Mayo Clinic School of Medicine (Rochester, Minn.)
6. Perelman School of Medicine at the University of Pennsylvania (Philadelphia)
8. David Geffen School of Medicine at UCLA (Los Angeles)
8. Washington University School of Medicine in St. Louis
10. Duke University School of Medicine (Durham, N.C.)
Here are the top 10 medical schools for primary care, including ties, as ranked by U.S. News.

 

1. UNC School of Medicine (Chapel Hill, N.C.)
2. UC San Francisco School of Medicine
3. UW School of Medicine (Seattle)
4. David Geffen School of Medicine at UCLA (Los Angeles)
5. Baylor College of Medicine (Houston)
5. OHSU School of Medicine (Portland, Ore.)
7. University of Michigan Medical School (Ann Arbor)
8. Perelman School of Medicine at the University of Pennsylvania (Philadelphia)
9. University of Colorado School of Medicine (Aurora)
10. UC Davis School of Medicine (Sacramento, Calif.)

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Methodology: 2019 Best Medical Schools Rankings






For the U.S. News rankings of the Best Medical Schools for Research, the 144 medical schools accredited in 2017 by the Liaison Committee on Medical Education and the 33 schools of osteopathic medicine accredited in 2017 by the American Osteopathic Association were surveyed in fall 2017 and early 2018. Of those 177 schools, 124 responded and provided the data needed to calculate the rankings based on the indicators used in the medical school research model.
U.S. News surveyed the same 177 medical schools at the same time for the primary care rankings, and the same 124 schools provided the data needed to calculate those rankings.
Both rankings are based on a weighted average of indicators, which are outlined below. The medical school research model is based on 12 indicators, and the primary care model is based on seven indicators.
Four of the data indicators are used in both the research and primary care ranking models. They are the student selectivity admissions statistics (MCAT, GPA and acceptance rate) and faculty-student ratio. The medical school research model factors in research activity; the medical school primary care model adds a measure of the proportion of M.D. graduates entering primary care specialties.
Quality Assessment (weighted by .30 for the research medical school model and .40 for the primary care medical school model)
• Peer assessment score (0.15 for the research medical school model, a decrease from 0.20 last year; 0.25 for the primary care medical school model): In fall 2017, medical and osteopathic school deans, deans of academic affairs and heads of internal medicine or directors of admissions were asked to rate programs on a scale from 1 (marginal) to 5 (outstanding). Those individuals who did not know enough about a school to evaluate it fairly were asked to mark "don't know."
Respondents were asked to rate program quality for both research and primary care programs separately on a single survey instrument. Thirty-one percent of those surveyed responded.
A school's score is the average rating of all the respondents who rated it; average scores were then sorted in descending order. Responses of "don't know" counted neither for nor against a school.
• Assessment score by residency directors (0.15 for the research medical school model, a decrease from 0.20 last year; 0.15 for the primary care medical school model): In fall 2017, as in previous years, residency program directors were also asked to rate programs using the same five-point scale on two separate survey instruments.
One survey dealt with research and was sent to a sample of residency program directors in fields outside primary care, including surgery, psychiatry and radiology. The other survey involved primary care and was sent to residency directors designated by schools as mainly involved in the primary care fields of family practicepediatrics and internal medicine.
]Survey recipients were asked to rate programs on a scale from 1 (marginal) to 5 (outstanding). Those individuals who did not know enough about a program to evaluate it fairly were asked to mark "don't know."
A school's score is the average rating of all the respondents who rated it in the three most recent years of survey results. Responses of "don't know" counted neither for nor against a school.
The medical schools themselves supplied the names of all of the residency program directors who were sent either of the residency program director surveys.
This year for the first time in the medical school primary care rankings, schools that received fewer than a total of 10 ratings from residency program directors in the three most recent years of the residency program directors survey received the lowest score achieved by any ranked primary care medical school for the purposes of calculating the rankings. These programs display an "N/A" instead of a residency program directors assessment score on usnews.com.
Ipsos Public Affairs collected the assessment data.
Research Activity (weighted by 0.40 in the research medical school model only, an increase from 0.30 last year; not used in the primary care medical school ranking model)
This year for the first time, based on suggestions from medical school deans, U.S. News added four new indicators of research activity to account for all the research conducted at medical schools: total non-NIH federal research activity, average non-NIH federal research activity per faculty member, total nonfederal research activity and average nonfederal research activity per faculty member. Each of these indicators was weighted at 0.025.
• Total NIH research activity (0.15): This is measured by the total dollar amount of NIH research grants awarded to the medical school and its affiliated hospitals, averaged for 2016 and 2017. An asterisk next to this data point in the rankings tables on usnews.com indicates that the medical school did not include grants to any affiliated hospitals in its 2017 total.
• Average NIH research activity per faculty member (0.15): This is measured by the dollar amount of NIH research grants awarded to the medical school and its affiliated hospitals per full-time faculty member, averaged over 2016 and 2017. Both full-time basic sciences and clinical faculty were used in the faculty count. An asterisk next to this data point in the rankings tables indicates that the medical school did not include grants to any affiliated hospitals in its 2017 total.
• Total non-NIH federal research activity (0.025): This is measured by the total dollar amount of non-NIH federal research awarded to the medical school and its affiliated hospitals in 2017. Examples of non-NIH federal sources include but are not limited to the Department of Defense, Office of Naval Research, National Science Foundation, U.S. Department of Veterans Affairs, Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services. An asterisk next to this data point in the rankings tables indicates that the medical school did not include grants to any affiliated hospitals in its 2017 total.
• Average non-NIH federal research activity per faculty member (0.025): This is measured by the dollar amount of non-NIH federal research grants awarded to the medical school and its affiliated hospitals per full-time faculty member in 2017. Both full-time basic sciences and clinical faculty were used in the faculty count. An asterisk next to this data point in the rankings tables indicates that the medical school did not include grants to any affiliated hospitals in its 2017 total.
• Total nonfederal research activity (0.025): This is measured by the total dollar amount of nonfederal research awarded to the medical school and its affiliated hospitals in 2017. Examples of non-NIH federal sources include but are not limited to corporations, associations, foundations, and state and local government funds. An asterisk next to this data point in the rankings tables indicates that the medical school did not include grants to any affiliated hospitals in its 2017 total.
• Average nonfederal research activity per faculty member (0.025): This is measured by the dollar amount of nonfederal research grants awarded to the medical school and its affiliated hospitals per full-time faculty member in 2017. Both full-time basic sciences and clinical faculty were used in the faculty count. An asterisk next to this data point in the rankings tables indicates that the medical school did not include grants to any affiliated hospitals in its 2017 total.
Primary Care Rate (0.30 in the primary care medical school model only; not used in research medical school ranking model)
The percentage of a school's M.D. or D.O. graduates entering primary care residencies in the fields of family practice, pediatrics and internal medicine was averaged over 2015, 2016 and 2017.
Student Selectivity (0.20 in the research medical school model; 0.15 in the primary care medical school model)
• Median MCAT total score (0.13 in the research medical school model; 0.0975 in the primary care medical school model): This is the median total Medical College Admission Test score of the 2017 entering class. For the second consecutive year, both the new MCAT that was implemented starting in April 2015 and the old MCAT were used in the rankings to compute the MCAT score indicator.
For both MCAT measures used in the ranking calculations, the median total scores for both the new and old versions were first converted to a common percentile scale and weighted by the proportion of the fall 2017 entering class who reported each test.
On usnews.com, only users with a U.S. News Medical School Compass subscription can view the new and old MCAT scores.
• Median undergraduate GPA (0.06 in the research medical school model; 0.045 in the primary care medical school model): This is the median undergraduate GPA of the 2017 entering class.
• Acceptance rate (0.01 in the research medical school model; 0.0075 in the primary care medical school model): This is the proportion of applicants for the 2017 entering class who were offered admission.
Faculty resources (0.10 in the research medical school model; 0.15 in the primary care medical school model): Faculty resources were measured as the ratio of full-time science and full-time clinical faculty to full-time M.D. or D.O. students in 2017.
For the second consecutive year, U.S. News used a logarithmic transformation of the original value for the faculty-student ratio since it had a skewed distribution. This logarithmic manipulation rescaled the data and allowed for a more normalized and uniform spread of values across the indicator.
After this indicator was normalized using a log value, its indicator z-score was calculated from the log values. In statistics, a z-score is a standardized score that indicates how many standard deviations a data point is from the mean of that variable. This transformation of the data is essential when combining diverse information into a single ranking because it allows for fair comparisons between the different types of data.
Overall Rank
Indicators were standardized about their means, and standardized scores were weighted, totaled and rescaled so that the top school received 100; other schools received their percentage of the top score. Medical schools were then numerically ranked in descending order based on their scores.
Specialty Rankings
These rankings, which include pediatrics and internal medicine, are based solely on ratings by medical school deans and senior faculty from the list of schools surveyed.
This year for the first time, U.S. News conducted specialty rankings in anesthesiology, obstetrics and gynecology, psychiatry, radiology and surgery. These fields were added based on suggestions from medical schools deans to better reflect the curriculum taught at medical schools.
Survey respondents each identified up to 10 schools offering the best programs in each specialty area.
Those schools receiving the most votes in each specialty are numerically ranked in descending order based on the number of nominations they received, as long as the school or program received seven or more nominations in that specialty area. This means that schools ranked at the bottom of each specialty ranking have received at least seven nominations.
The specialty areas of drug and alcohol abuse, family medicine, geriatrics, rural medicine and women's health are no longer surveyed.
Rank Not Published
For both research medical schools and primary care medical schools, U.S. News has numerically ranked the top three-fourths of the schools. The bottom quarter of the research medical schools and primary care medical schools are listed as Rank Not Published.
Rank Not Published means that U.S. News calculated a numerical rank for that school but decided for editorial reasons not to publish it. U.S. News will supply schools listed as Rank Not Published with their numerical ranks if they submit a request following the procedures listed in the Information for School Officials.
Schools marked as Ranked Not Published are listed alphabetically.
Unranked
 
If a school is marked as Unranked, that means that U.S. News did not calculate a numerical rank because the school did not supply enough key statistical data to be numerically ranked. Unranked schools are listed alphabetically below those marked as Rank Not Published.