Navegando por Palavras-chave "Decision Making"
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- ItemSomente MetadadadosAdaptação transcultural para a língua portuguesa do Brasil de um guia autoinstrucional para avaliação do raciocínio clínico de estudantes de enfermagem(Universidade Federal de São Paulo (UNIFESP), 2020-05-28) Guandalini, Lidia Santiago [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São PauloIntroduction The use of clinical reasoning prompts (CRP) for nursing students can increase their diagnostic accuracy during the resolution of case studies, contributing to the teaching-learning process and patient safety. Objective: To estimate the validity of the CRP for assessing the clinical reasoning of nursing students. Method: A methodological study of translation and cross-cultural adaptation into Brazilian Portuguese of: 1) CRP; 2) case studies; 3) a questionnaire on students’ perceptions during decision making in case studies; 4) a scoring manual to correct the case studies. To carry out translation and cross-cultural adaptation, steps 1 to 8 of the Guidelines for Establishing Cultural Equivalency of Instruments of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Consortium Network were adopted: 1) Translation from the original language to the target language; 2) Synthesis and resolution of discrepancies of the two or more translations; 3) Back translation; 4) Review of back translation by the author of the original instrument; 5) Review and iterative development related to items with translation and back-translation problems; 6) Consolidation of all translation and assessment in a single instrument suitable for internal assessment; 7) Review by a committee of experts regarding cultural equivalence and content validity (clarity and practical relevance). The agreement values among experts > 80% and content validity coefficient (CVC)> 0.8 were considered satisfactory; 8) Preparation of the pre-final instrument and 9) Pre-test: randomized clinical trial with 24 nursing students (Intervention Group, n=14, using CRP to solve case studies and Control Group, n=10, without using the CRP). Results: the GARC was translated and adapted to the Portuguese language in Brazil, being placed for the location of agreement between the judges above 80% and the CVC above 0.80 with respect to content validity. Regarding face validation, adequate agreement was obtained in the assessment by the students. In the pre-test, there was no difference in the accuracy of nursing diagnoses between the Intervention and Control groups. Conclusion: The GARC was translated and adapted to the Portuguese spoken in Brazil and indicated according to the indication of face and content. The preliminary use of GARC, however, was not associated with an improvement in the diagnostic accuracy of nursing students.
- ItemSomente MetadadadosAnálise das áreas neurais envolvidas na tomada de decisão em ratos submetidos à ingestão crônica de álcool(Universidade Federal de São Paulo (UNIFESP), 2017-03-14) Zangirolame, Carolline Marques Santos [UNIFESP]; Céspedes, Isabel Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Drug dependence is a worldwide and frequent problem involving young people and adults, with alcohol being the drug most commonly used and associated with numerous social and health problems. However, not all people who drink alcohol become dependent. The transition from occasional use to dependence is influenced by positive and negative refluxes (relief of unpleasant symptoms such as stress or depression or withdrawal symptoms). Compulsive alcohol ingestion has been strongly associated with neurotransmission systems involved in reward (mainly dopaminergic) and stress response (mainly CRFergic) processes. Loss of control is attributed to a dysfunction of regions belonging to these two systems, the pre-frontal cortex, the hippocampus and the companion, which form the main circuit of decision making. This study aimed at analyzing the neural areas of superior control of the stress response and that are also associated with behavioral decision making (pre-frontal cortex, hippocampus and amygdala) in Wistar rats submitted to chronic alcohol ingestion by the paradigm of two bottles and intermittent supply protocol. Animals of the control group and the alcohol group underwent the tests of labyrinth in elevated cross and open field to evaluate their anxiety state, by the test of decision making for behavioral evaluation of this task and after euthanasia of this animals was performed immunoreactivity to the protein ΔFosB, to analyze the level of neuronal activation of the areas associated to the decision making described above. The protocol of intermittent supply and oral administration of 20% alcohol to Wistar rats during the studied period (four weeks) did not promote a significant increase in the consumption pattern of the alcohol solution during the period, did not interfere in the weight or in the consumption of the feed. Also, this chronic consumption of alcoholic solution had no effect on anxiety and decision-making behaviors. Nevertheless, the immunoreactivity data to the DelaFosB protein showed that the animals that consumed the alcoholic solution showed hypoactivity in the area corresponding to the infra-limbic cortex, and hyperactivity in the central amygdala and the hippocampus CA3 area, demonstrating less activity in one Area of rational behavior control, and greater activity in an area associated with memory recruitment and in another area associated with impulsive decision making.
- ItemSomente MetadadadosInitiation of resuscitation in the delivery room for extremely preterm infants: a profile of neonatal resuscitation instructors(Hospital clinicas, univ sao paulo, 2016) Ambrosio, Cristiane Ribeiro; Sanudo, Adriana [UNIFESP]; Branco de Almeida, Maria Fernanda [UNIFESP]; Guinsburg, Ruth [UNIFESP]OBJECTIVE: The goal of the present study was to examine the decisions of pediatricians who teach neonatal resuscitation in Brazil, particularly those who start resuscitation in the delivery room for newborns born at 23-26 gestational weeks. METHODS: The present study was a cross-sectional study that used electronic questionnaires (Dec/11-Sep/13) sent to instructors of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. The primary outcome was the gestational age at which the respondent said that he/she would initiate positive pressure ventilation in the delivery room. Latent class analysis was used to identify the major profiles of these instructors, and logistic regression was used to identify variables associated with belonging to one of the derived classes. RESULTS: Of 685 instructors, 82% agreed to participate. Two latent classes were identified: 'pro-resuscitation' (instructors with a high probability of performing ventilation on infants born at 23-26 weeks) and 'prolimitation' (instructors with a high probability of starting ventilation only for infants born at 25-26 weeks). In the multivariate model, compared with the 'pro-limitation' class, 'pro-resuscitation' pediatricians were more likely to be board-certified neonatologists and less likely to base their decision on the probability of the infant's death or on moral/religious considerations. CONCLUSION: The pediatricians in the most aggressive group were more likely to be specialists in neonatology and to use less subjective criteria to make delivery room decisions.