Browsing by Author "Lopes, L"
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- Cholangioscopy-guided holmium laser lithotripsy of a stone trapped in a mechanical lithotripterPublication . Libânio, D; Giestas, S; Martinez-Ares, D; Canena, J; Lopes, L
- Effectiveness of the flipped classroom methodology In the performance of higher education students: systematic review with meta-analysisPublication . Santos, Hugo; Santos, A; Rodrigues, C; Valeriano, J; Lopes, L; Freitas, M J; Esteves, R; Silva, CIntroduction: The methodology Flipped Classroom (FC) consists in individual activities that the student has to do at home through the use of technologies which help the student to prepare for class, and during classes, activities are performed as more dynamic classes centered on the student. Through the years, the success has reached the maximum levels of performance and satisfaction in the teaching sessions in different areas of education compared to the classical methods, and there are no conclusive and considerable studies that compile and analyze this information succinctly. Objective: To analyze experimental and quasi-experimental studies that evaluate the methodology database in FC in performance and student satisfaction in comparison with the expository methodology. Methodology: This article is a systematic review that analyzes the randomized controlled trial (RCT) and Quasi-experimental studies selected with the methodology FC, which measures the efficacy through the results achieved in the realization and evaluation of the students. These articles were found in EBSCOhost and PubMed. Results: We selected 41 articles, that fulfilled all inclusion criteria established by the authors, for the accomplishment of this systematic review. Discussion: The results of our meta-analysis, both RCTs and quasi-experimental studies, point to a better effectiveness of the FC methodology compared to the expository methodology in academic performance. However, there is a heterogeneity in planned and developed activities during class, which means that our conclusions can’t be generalized. The poor methodological quality of the included studies, especially quasi-experimental studies, does not allow our conclusions about efficacy to be vigorous. Nevertheless, based on these first promising data, it seems to us that this methodology offers learning opportunities that aren’t possible in a classroom based on lectures and subject matter exposition. Conclusion: Although the articles selected have poor methodological quality, and it is necessary more rigorous investigations on this methodology, we believe that the FC methodology could revolutionize teaching methods and replace traditional teaching, which is so deeply rooted in today's society and doesn’t seems to favor the achievement of transversal competences.
- Effectiveness of the flipped classroom methodology in the performance of higher educationh students: systematic review with meta-analysisPublication . Santos, Hugo; Santos, A; Rodrigues, C; Valeriano, J; Lopes, L; Freitas, M J; Esteves, R; Silva, Cntroduction: The methodology Flipped Classroom (FC) consists in individual activities that the student has to do at home through the use of technologies which help the student to prepare for class, and during classes, activities are performed as more dynamic classes centered on the student. Through the years, the success has reached the maximum levels of performance and satisfaction in the teaching sessions in different areas of education compared to the classical methods, and there are no conclusive and considerable studies that compile and analyze this information succinctly. Objective: To analyze experimental and quasi-experimental studies that evaluate the methodology database in FC in performance and student satisfaction in comparison with the expository methodology. Methodology: This article is a systematic review that analyzes the RCT and Quasi - experimental studies selected with the methodology FC, which measures the efficacy through the results achieved in the realization and evaluation of the students. These articles were found in EBSCOhost and PubMed. Results: We selected 41 articles, that fulfilled all inclusion criteria established by the authors, for the accomplishment of this systematic review. The results of our meta-analysis, both RCTs and quasi experimental studies, point to a better effectiveness of the FC methodology compared to the expository methodology in academic performance. However, there is a heterogeneity in planned and developed activities during class, which means that our conclusions can’t be generalized. The poor methodological quality of the included studies, especially quasi-experimental studies, does not allow our conclusions about efficacy to be vigorous. Nevertheless, based on these first promising data, it seems to us that this methodology offers learning opportunities that aren’t possible in a classroom based on lectures and subject matter exposition. Conclusion: Although the articles selected have poor methodological quality, and is necessary more rigorous investigations on this methodology, we believe that the FC methodology could revolutionize teaching methods and replace traditional teaching, which is so deeply rooted in today's society and doesn’t seems to favor the achievement of transversal competences.
- Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary AccessPublication . Libânio, D; Giestas, S; Martinez-Ares, D; Ferreira, F; Canena, J; Certo, M; Lopes, LINTRODUCTION: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. CLINICAL CASE: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. DISCUSSION: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.
- Esophageal Anastomotic Stricturotomy: Electroincision Therapy with a Needle KnifePublication . Fernandes, J; Libânio, D; Giestas, S; Ramada, J; Martinez-Ares, D; Canena, J; Lopes, L
- Factors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 PatientsPublication . Alexandrino, G; Lopes, L; Fernandes, J; Moreira, M; Araújo, T; Campos, S; Loureiro, R; Figueiredo, L; Lourenço, LC; Horta, D; Bana e Costa, T; Costa, P; Canena, JBackground: Peroral cholangioscopy (POC)-guided lithotripsy is an effective treatment for difficult biliary stones. A clear definition of factors associated with the efficacy of POC-guided lithotripsy in one session and the performance of electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have not clearly emerged. Methods: This was a non-randomized prospective multicenter study of all consecutive patients who underwent POC lithotripsy (using EHL and/or LL) for difficult biliary stones. The primary endpoint of the study was the number of sessions needed to achieve complete ductal clearance and the factors associated with this outcome. Secondary endpoints included the evaluated efficacies of LL and EHL. Results: Ninety-four patients underwent 113 procedures of EHL or LL. Complete ductal clearance was obtained in 93/94 patients (98.94%). In total, 80/94 patients (85.11%) achieved stone clearance in a single session. In the multivariate analysis, stone size was independently associated with the need for multiple sessions to achieve complete ductal clearance (odds ratio = 1.146, 95% confidence interval: 1.055-1.244; p = 0.001). Using ROC curves and the Youden index, 22 mm was found to be the optimal cutoff for stone size (95% confidence interval: 15.71-28.28; p < 0.001). The majority of the patients (62.8%) underwent LL in the first session. Six patients failed the first session with EHL after using two probes and therefore were crossed over to LL, obtaining ductal clearance in a single additional session with a single LL fiber. EHL was significantly associated with a larger number of probes (2.0 vs. 1.02) to achieve ductal clearance (p < 0.01). The mean procedural time was significantly longer for EHL than for LL [72.1 (SD 16.3 min) versus 51.1 (SD 10.5 min)] (p < 0.01). Conclusions: POC is highly effective for difficult biliary stones. Most patients achieved complete ductal clearance in one session, which was significantly more likely for stones < 22 mm. EHL was significantly associated with the need for more probes and a longer procedural time to achieve ductal clearance.