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The objective of this study was to compare the effectiveness of Problem Based Learning (PBL) versus PBL associated with the Active Learning Model for Critical Thinking (ALMCT) to improve critical thinking (CT) in nursing students in an educational intervention on Basic Life Support (BLS). A two-arm randomized, single-blinded, parallel clinical trial was carried out with 108 Brazilian undergraduate nursing students who participated in a BLS course. PBL + ALMCT was used in the control group (CG), and PBL was used in the experimental group (EG). Pre- and post-tests were used to evaluate CT dispositions using the California Critical Thinking Dispositions Inventory (CCTDI), and CT skills were evaluated using the California Critical Thinking Skills Test (CCTST). The results did not indicate significant differences between the CG and EG groups for total CCTDI and total CCTST scales and for most of their subscales. However, there was a significant difference in the EG when the mean scores on the pre- and post-test were compared on the CCTDI analyticity subscale (t = 2073; p = 0.043) and on the CCTST analysis subscale (t = 2302; p = 0.025). We strongly recommend further studies using PBL associated with ALMCT and randomized clinical trials that last more than one month., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: The aim of this review is to identify and synthesize the best available evidence on the effectiveness of teaching strategies aimed at improving critical thinking (CT) in registered nurses who provide direct patient care. Specifically, the research question is: What are the best teaching strategies to improve CT skills in registered nurses who provide direct patient care?

Context and Objective: There are few data in the literature on the frequency of cholecystectomy in Brazil. The frequency of cholecystectomy and associated risk factors were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)., Design and Setting: Cross-sectional study using baseline data on 5061 participants in São Paulo., Methods: The frequency of cholecystectomy and associated risk factors were evaluated over the first two years of follow-up of the study and over the course of life. A multivariate regression analysis was presented: odds ratio (OR) and 95% confidence interval (95% CI)., Results: A total of 4716 individuals (93.2%) with information about cholecystectomy were included. After two years of follow-up, 56 had undergone surgery (1.2%: 1.7% of the women; 0.6% of the men). A total of 188 participants underwent cholecystectomy during their lifetime. The risk factors associated with surgery after the two-year follow-up period were female sex (OR, 2.85; 95% CI, 1.53-5.32), indigenous ethnicity (OR, 2.1; 95% CI, 2.28-15.85) and body mass index (BMI) (OR, 1.10; 95% CI, 1.01-1.19 per 1 kg/m2 increase). The risk factors associated over the lifetime were age (OR, 1.03; 95% CI, 1.02-1.05 per one year increase), diabetes (OR, 1.92; 95% CI, 1.34-2.76) and previous bariatric surgery (OR, 5.37; 95% CI, 1.53-18.82). No association was found with parity or fertile age., Conclusion: Female sex and high BMI remained as associated risk factors while parity and fertile age lost significance. New factors such as bariatric surgery and indigenous ethnicity have gained importance in this country.

A typical case of Fahr's syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous system detected multiple calcifications, with characteristic distribution of Fahr's syndrome. Clinical management was successful.

Objective: To analyze the spatial distribution of leprosy, identify areas of potential case underreporting or high transmission risk, and to assess the ecological association of leprosy distribution with multibacillary cases., Methods: This study was carried out in 94 neighborhoods of Recife, Brazil. Data was obtained from the Ministry of Health's Disease Reporting System. An ecological approach with the empirical Bayesian method was applied for local rate flattening, using data from a neighborhood matrix., Results: The mean annual occurrence was 17.3% of new cases in individuals under the age of 15 (28.3% corresponded to multibacillary forms), revealing an intense disease transmission. The spatial distribution of leprosy indicated three areas where there was a concentration of high detection rates and low-income neighborhoods., Conclusions: The Bayesian method allowed to reassess epidemiological indicators based on data from neighboring spatial units. This enabled to identify areas that should be prioritized in municipal control programs, either because of underreporting of cases or the higher number of occurrences related to multibacillary forms in individuals under 15.