Introdução: A doença pulmonar na fibrose cística (FC) é obstrutiva e supurativa, caracterizada por exacerbações recorrentes dos sintomas respiratórios e pela deterioração progressiva da função pulmonar. A gravidade da doença pulmonar é mensurada pelo volume expiratório forçado no primeiro segundo (VEF1), obtido através da espirometria. O VEF1 é um preditor de mortalidade bem documentado na literatura, utilizado como desfecho em ensaios clínicos e como parâmetro para indicar e monitorizar respostas terapêuticas. O objetivo do estudo foi avaliar o impacto da realização da espirometria em todas as consultas médicas na frequência das intervenções clínicas e na função pulmonar dos pacientes com FC. Métodos: Pacientes com diagnóstico de FC em acompanhamento em centro de referência, com idade entre 5-18 anos, realizaram uma espirometria antes de cada consulta médica durante o período de um ano (2014). Os dados coletados durante o seguimento foram comparados com o período de 24 meses anteriores ao estudo, período no qual os pacientes realizavam rotineiramente apenas uma espirometria a cada seis meses. Os principais desfechos avaliados foram diagnóstico de exacerbação pulmonar, frequência de introdução de novas terapias de uso crônico, encaminhamento ao ambulatório de transplante pulmonar e média do VEF1 basal. A utilização da espirometria para tomada de decisão clínica foi referida pelo médico assistente através de questionário. Resultados: Participaram do estudo 80 pacientes (idade média 12,1 anos e 61,3% do sexo masculino), tendo sido realizadas 418 consultas durante o ano de seguimento (5,2 consultas por paciente/ano). Exacerbações pulmonares foram diagnosticadas em 27,5% das consultas, com taxa de 1,44 exacerbações pulmonares por paciente/ano, frequência significativamente maior quando comparada com os anos 2012 (p=0,001) e 2013 (p=0,05). A espirometria foi útil para diagnóstico de exacerbação pulmonar em 83,5% das vezes, e em 21,9% destes casos o diagnóstico de exacerbação foi feito exclusivamente pelo parâmetro do declínio agudo do VEF1. Terapias de uso crônico foram introduzidas 0,4 vezes por paciente/ano, sem diferença estatisticamente significante com os períodos anteriores. A espirometria foi útil em 83,9% das vezes em que se iniciou uma nova terapia. Foram realizados três encaminhamentos para o serviço de transplante pulmonar, sem diferença estatística com os períodos anteriores. A média do VEF1 basal da amostra foi de 80% do previsto (DP+28,2), sem diferença significativa com os valores observados nos anos anteriores 78,1% em 2013 (p=0,27); e 76,7% em 2012 (p=0,7), indicando tendência para manutenção da função pulmonar destes pacientes. Conclusão: O estudo evidencia um impacto significativo da realização da espirometria rotineira em todas as consultas médicas no aumento do reconhecimento e tratamento de exacerbações pulmonares, com potenciais benefícios na função pulmonar destes pacientes / Background: Pulmonary disease in cystic fibrosis (CF) is obstructive and suppurative, characterized by recurrent exacerbations of respiratory symptoms and progressive deterioration of lung function. The severity of lung disease is measured by forced expiratory volume in the first second (FEV1), obtained through spirometry. FEV1 is a well documented predictor of mortality in the literature, used as an endpoint in clinical trials and as a parameter for indicating and monitoring therapeutic responses. The aim of the study was to evaluate the impact of performing spirometry during routine medical visits on the frequency of clinical interventions and lung function in CF patients. Methods: Patients with a diagnosis of CF in follow-up at the reference center, aged 5-18 years, underwent spirometry before each clinical visit during a one-year period (2014). Data collected during follow-up were compared with the 24-month period prior to the study, during which patients routinely performed only one spirometry every six months. The outcomes included diagnosis of pulmonary exacerbation, frequency of introduction of new therapies for chronic use, referral for pulmonary transplantation, mean baseline FEV1. The use of spirometry for clinical decision making was reported by the attending physician by questionnaire. Results: 80 patients (mean age 12.1 years and 61.3% males) participated in the study, and 418 visits were performed during the year of follow-up (5.2 visits per patient/year). Pulmonary exacerbations were diagnosed in 27.5% of the consultations, with a rate of 1.44 pulmonary exacerbations per patient/year, significantly higher than the year of 2012 (p = 0.001) and 2013 (p = 0.05). Spirometry was useful for diagnosis of pulmonary exacerbation in 83.5% of the time, and in 21.9% of these cases the diagnosis of exacerbation was made exclusively by the parameter of the acute decline of FEV1. Chronic use therapies were introduced 0.4 times per patient/year, with no statistically significant difference with previous periods. Spirometry was useful in 83.9% of the times a new therapy was started. Three referrals were made for pulmonary transplantation, with no statistical difference with previous periods. The mean baseline FEV1 of the sample was 80% predicted (SD+28.2), compared to 78.1% in 2013 (p=0.27); and 76.7% in 2012 (p=0.7), indicating a tendency for stabilization of the pulmonary function of these patients. Conclusion: The study evidences a significant impact of routine spirometry during routine encounters of CF patients in the increase of diagnosis and treatment of pulmonary exacerbations, with potential benefits for the pulmonary function of these patients

<p>Physicians are supposed to act as sick-listing experts and they possess a role as gate-keepers to the social insurance system. Earlier studies have demonstrated variation between physicians and physician categories regarding sick-listing practice. In addition to the patient's disease and its severity, a number of other factors may be expected to influence sick-listing practice. Most earlier studies have focused on the patient's disease and his or her work place as cause for sickness absence.</p><p>The aims of this study were to analyse variation of sick-listing practice between physician categories and the influence of physician characteristics on sick-listing practice, the influence of structure, organisation and remuneration of health care on physician sick-listing practice, the influence of local structural factors in the community, and the influence of a legislative change on physician sick-listing practice.</p><p>The study was conducted as a cross-sectional epidemiological study of 57563 doctors’ certificates for sickness absence, received by 28 local social insurance offices in eight Swedish counties, during four months in 1995 and two months in 1996.</p><p>Patient age, sex, and diagnostic group, issuing physician category, presence of a hospital in the municipality, municipality population size and county were all significantly and independently correlated to number of net days of sick-listing. Physician characteristics, such as age, sex and degree of specialisation were all associated with number of net days of sick-listing. Physicians working in general practice issued significantly shorter periods of sick-listing than the other physician categories. Reimbursement of general practice and participation in financial co-operation with social insurance were significantly correlated to length of sickness episode issued by general practitioners. A legislative change performed during the study period was associated with small effects in sick-listing practice.</p><p>In conclusion, a number of factors other than disease and disease severity and other patient and physician linked factors were found to influence the variation of sick-listing practice. It appears that the closer the influencing factor was to the place were the decision was taken, i.e., the patient-physician consultation, the higher the impact on the decision appeared to be.</p>

Physicians are supposed to act as sick-listing experts and they possess a role as gate-keepers to the social insurance system. Earlier studies have demonstrated variation between physicians and physician categories regarding sick-listing practice. In addition to the patient's disease and its severity, a number of other factors may be expected to influence sick-listing practice. Most earlier studies have focused on the patient's disease and his or her work place as cause for sickness absence. The aims of this study were to analyse variation of sick-listing practice between physician categories and the influence of physician characteristics on sick-listing practice, the influence of structure, organisation and remuneration of health care on physician sick-listing practice, the influence of local structural factors in the community, and the influence of a legislative change on physician sick-listing practice. The study was conducted as a cross-sectional epidemiological study of 57563 doctors’ certificates for sickness absence, received by 28 local social insurance offices in eight Swedish counties, during four months in 1995 and two months in 1996. Patient age, sex, and diagnostic group, issuing physician category, presence of a hospital in the municipality, municipality population size and county were all significantly and independently correlated to number of net days of sick-listing. Physician characteristics, such as age, sex and degree of specialisation were all associated with number of net days of sick-listing. Physicians working in general practice issued significantly shorter periods of sick-listing than the other physician categories. Reimbursement of general practice and participation in financial co-operation with social insurance were significantly correlated to length of sickness episode issued by general practitioners. A legislative change performed during the study period was associated with small effects in sick-listing practice. In conclusion, a number of factors other than disease and disease severity and other patient and physician linked factors were found to influence the variation of sick-listing practice. It appears that the closer the influencing factor was to the place were the decision was taken, i.e., the patient-physician consultation, the higher the impact on the decision appeared to be.

A lack of information is identified on the ability of professional nurses working in a neonatal intensive care unit to make competent clinical decisions pertaining to the employment of bedside blood product filters during neonatal transfusion. In addition, a lack of complete guidelines existed to aid professional nurses in instances where they are faced with such a decision. A descriptive survey was conducted to determine and describe the knowledge professional nurses working in neonatal intensive care unit have regarding the employment of bedside blood product filters during the transfusion of a neonate with blood or blood products, as well as their ability to make competent clinical decisions in the regard. A questionnaire was designed, which was validated by experts in neonatal intensive care nursing and blood transfusion. The questionnaires were distributed to 10 nominated public and private hospitals with neonatal intensive care units in Gauteng, South Africa, for completion. Participants were self-nominated; they participated in the study of their own free will. Neither the participants’ nor the hospitals’ names were revealed at any stage. Numbers were used to identify the questionnaires. 120 questionnaires were completed and were analysed using descriptive statistics. In the following step, the results obtained from the questionnaires together with literature were used to recommend guidelines for neonatal transfusion utilisation by professional nurses working in neonatal intensive care units. The recommended guidelines were divided into two categories: General guidelines and Specific blood products guidelines. Validity and reliability was enhanced by using staff from ten neonatal intensive care units from the private and public health care sector in Gauteng, South Africa; obtaining a sufficient sample size (n=120); involvement of experts in the field of neonatal nursing science and blood transfusion, as well as a statistician from the University of Pretoria; and verification of results with literature. Ethical principles were adhered to: confidentiality was maintained as no names of any of the hospitals or the participants were disclosed. All information regarding the study was provided to the relevant parties and the participants voluntarily signed an informed consent form. Permission to conduct the study was obtained from the selected hospitals’ management. Approval to conduct the study was obtained from the Ethics Committee of the Faculty of Health Science, University of Pretoria. There were no known risks involved in the study. Recommendations were made for more research on the same topic to be conducted and their outcomes be compared to the results yielded by this study and research to be conducted to related topics. The findings of this study were meant to improve the clinical practice of nursing in neonatal intensive care units. It was therefore recommended that these guidelines be implemented by neonatal intensive care units, training institutions and the South African Blood Transfusion Services. AFRIKAANS : Die navorser het ’n intensiewe oorsig van die bestaande literatuur rakende die kliniese besluitneming van professionele verpleegkundiges in neonatale intensiewe sorgeenhede gedoen. Dit het duidelik uit dié navorsingsoorsig geblyk dat daar baie min gedoen is om die vermoëns vas te stel van professionele verpleegkundiges wat in die neonatale intensiewe sorgeenheid werk met betrekking tot kliniese besluitneming wat die aanwending van bloedprodukfilters tydens neonatale transfusie betref. Aanvullend het die oorsig onthul dat daar geen volledige riglyne bestaan, of voorsien word, vir professionele verpleegkundiges in gevalle waar hul met so ’n besluit gekonfronteer word. Die studie is in twee fases gedoen. In Fase een is ’n vraelys ontwerp gebaseer op konsepte en temas uit die literatuur geїdentifiseer, waarna dit gevalideer is deur kundiges. Die vraelyste is uitgegee aan 10 genomineerde privaat- en publieke hospitale met neonatale inesiewe sorgeenhede in Gauteng vir voltooiing. Die voltooide vraelyste is gesorteer en geanaliseer. Deelnemers is self-genomineerd; die navorser het hulle toegelaat om self te besluit of hulle wou deelneem aan die studie of nie. Deelnemers en hospitale se name is op geen stadium bekend gemaak nie. Nommers is gebruik om die vraelyste te identifiseer. In Fase twee is die uitslae van die vraelyste gebruik om riglyne te ontwerp om gebruik te word in neonatale intensiewe sorgeenhede deur professionele verpleegkundiges vir neonatale transfusie. Riglyne vir neonatale transfusie is geformuleer volgens die uitkoms van die vraelyste in kombinasie sowel as die oorsig van die reeds bestaande literatuur deur middel van induktiewe en deduktiewe beredenering. Aangesien professionele verpleegkundiges kennis moet dra van algemene riglyne om spesifieke riglyne te kan toepas, is die riglyne in twee kategorieë verdeel: Algemene riglyne en Spesifieke bloedprodukte riglyne. Deur hierdie studie in twee verskillende omgewings, naamlik privaat- en publieke instansies te doen, en 10 eenhede van een area (Gauteng) in Suid- Afrika daarby te betrek, sowel as om ’n relatief groot steekproef te gebruik, is die oordraagbaarheid van die uitkoms van die studie na ander streke verhoog. Die navorser het aanbeveel dat verdere studies oor dieselfde onderwerp gedoen word, en die uitkomste daarvan vergelyk word met die resultaat van hierdie studie. Die uitkoms die studie sal dan meer oordraagbaar wees na ander streke in Suid-Afrika. Die uitgebreide literatuuroorsig, die betrokkenheid van kundiges en die navorser se eie ondervinding en kennis in die neonatale intensiewe sorgverpleegkunde, het bygedra tot die vertrouenswaardigheid van die studie. Kundiges op die gebied van neonatale verpleegkunde en bloedtransfusie was betrokke, sowel as ’n biostatistikus verbonde aan die Universiteit van Pretoria. Etiese beginsels is gevolg. Die navorser was nie bewus van, en is ook nie gekonfronteer met enige etiese dilemmas of probleme tydens die studie nie. Konfidensialiteit is deurgaans gehandhaaf in die studie deurdat geen name van die deelnemers of hospitale genoem is nie. Alle inligting met betrekking tot die studie is aan die relevante partye verstrek en die deelnemers het almal uit eie vrye wil ’n ingeligte toestemmingsvorm onderteken. Toestemming om die studie te doen is ook verkry van die genomineerde hospitale se bestuur. Toestemming om die studie te doen is verkry van die Etiese Komittee van die Fakulteit van Gesondheidswetenskappe, Universiteit van Pretoria. Daar was geen risiko’s betrokke aan die studie nie, slegs voordele, aangesien die doel van die studie was om die professionele verpleegkundiges in die neonatale intensiewe sorgeenhede behulpsaam te wees met besluitneming rakende die gebruik van bloedprodukfilters tydens transfusie van bloed of bloedprodukte aan ’n neonaat. Die bevindings van die studie is bedoel om die kliniese praktyk van verpleging in neonatale intensiewe sorgeenhede te verbeter. Gevolglik word ’n aanbeveling gemaak dat hierdie riglyne geïmplimenteer word in neonatale intensiewe sorgeenhede, opleidingsinstansies sowel as die Suid-Afrikaanse Bloedoortappingsdiens. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

The present study starts from the premise that the academic formation has a strong influence in the development of critical thinking, clinical reasoning and in the decision making of the student of pharmacy. The objective of the study was to highlight what has been used for the development of critical thinking, clinical reasoning and decision making in pharmacy student training. Therefore, a systematic review was carried out. The studies were extracted from the databases: LILACS, PubMed / MEDLINE, Scopus, Web of Science. The words "Thinking", "Education pharmacy", "Students, Pharmacy", "Clinical decision-making" along with their terms of entry were used as descriptors. Two reviewers independently conducted the evaluation of titles, abstracts and articles in their entirety. The evaluation of methodological quality followed the quality checklist of a BEME (Best Evidence in Medical Education) research group. Of the 11 studies included, nine reached an expected quality index. The results of these studies indicated that pharmacy students when enrolled in pre-pharmacy, PharmD and undergraduate programs in four years in the North American context, or PharmD programs based on active methodologies in the Mexican and Saudi context can significantly improve some aspects / Scores of critical thinking of pharmacy students. Although positive results have been observed, further studies are needed, as the role of academic training in the development of critical thinking, and especially in the clinical thinking and decision-making of the pharmacy student, is not yet clear. However, the literature points to the need for curricular reformulation of undergraduate courses in pharmacy, geared to its multidimensional context, since curricular were identified primarily during performance improvement in critical thinking. / O presente estudo parte da premissa de que a formação acadêmica tem uma forte influência no desenvolvimento do pensamento crítico, raciocínio clínico e na tomada de decisões do estudante de farmácia. O objetivo do estudo foi diagnosticar o que vem sendo utilizado para o desenvolvimento do pensamento crítico, raciocínio clínico e tomado de decisão na formação do estudante de farmácia. Para tanto, foi realizada uma revisão sistemática. Os estudos foram extraídos das bases de dados: LILACS, PubMed/MEDLINE, Scopus, Web of Science. Como descritores foram utilizadas as palavras: “Thinking”, “Education pharmacy”, “Students, Pharmacy”, "Clinical decision-making" juntamente com seus termos de entrada. Dois revisores de forma independente conduziram a avaliação dos títulos, resumos e artigos na íntegra. A avaliação da qualidade metodológica seguiu o cheklist de qualidade de um grupo de pesquisa BEME (Best Evidence in Medical Education). Dos 11 estudos incluídos, nove atingiram um índice de qualidade esperado. Os resultados destes estudos apontaram que os estudantes de farmácia quando inseridos em programas de pre-pharmacy, PharmD de graduação em quatro anos no contexto norte-americano, ou em programas PharmD baseados em metodologias ativa no contexto mexicano e saudita pode melhorar significativamente alguns aspectos/escores do pensamento crítico de estudantes de farmácia. Embora tenham sido observados resultados positivos outros estudos são necessários, uma vez que ainda não está claro o papel da formação acadêmica no desenvolvimento do pensamento crítico, e principalmente do raciocínio clínico e na tomada de decisões do estudante de farmácia. Entretanto, a literatura aponta para a necessidade de reformulação curricular dos cursos de graduação em farmácia, voltados a seu contexto multidimensional, uma vez que foram identificados primordialmente aspectos curriculares, durante a melhoria de desempenho no pensamento crítico. / São Cristóvão, SE

Cette recherche qualitative identifie le rôle de l’expérience face à l’intuition et à l’émotion dans la décision clinique de l’infirmière d’accueil et d’orientation des urgences hospitalières. La problématique du rôle triple de l’expérience sur le raisonnement, sur la nature et le contrôle du « ressenti » éprouvé dans le feu de l’action est étudiée au travers de l’influence de la posture de connaissance face à l’expérience induisant l’acquisition et l’usage de savoirs explicites et implicites (Dewey, 2004) agissant sur le modèle opératif de pensée d’un professionnel (Pastré, 2011). La méthodologie, orientée par une posture théorique multi référentielle (Ardoino,1986), articule les approches de la décision en économie (Simon, 1983), en neurosciences (Berthoz, 2003 ; Damasio, 1995) avec les travaux sur l’intuition dans la pensée bi-systémique (Kahneman, 2016) et les approches du rôle cognitif des émotions (Livet, 2002 ; Rimé, 2009, Thievenaz, 2017). Des entretiens semi-directifs et d’explicitation (Vermersch, 1994) sont conduits auprès de vingt infirmiers-ères, de deux hôpitaux.Six propositions théoriques émanent des résultats. L’existence d’une posture « cognitivo-émotionnelle » face à l’expérience vécue dans l’action est découverte. Elle génère un mode et des modalités de raisonnement et d’élaboration d’indicateurs cliniques ou de savoirs d’action mais aussi un mode décisionnel à partir du vécu de l’expérience. Elle influence la nature « ressenti » qui est intuition ou émotion ou étonnement. Selon sa posture, l’infirmière cherche à confirmer son intuition. Elle cherche des preuves à son étonnement, régule son émotion ou renonce à prendre une décision, ou se protège de tout « ressenti ». / This doctoral thesis’ research identifies the roles of experience in the effects of intuition or emotion and clinical reasoning and characterizes the nature of the “feeling” rising; The “multiréférentiel” (Ardoino, 1986)theoretical and methodological framework links a pragmatist understanding of implicit or explicit experiential learning’s through an active or passive knowing posture (Dewey, 2004) with theoretical works concerning the decision processing in economics (Simon, 1983), in neurosciences (Berthoz, 2003; Damasio, 1995) and with the cognitive function of emotion (Livet, 2002;Rimé, 2009). Intuition is replaced in dual process theories of cognition (Kahneman, 2016). Data were collected from two French Parisian emergency’s departments through twenty emergency nurses differently experienced in triage, volunteered to take part in the study,. Semistructured interview collected the nurses’posture of knowing. “Elicitation interviews’” (Vermersch, 1994)recalled nurses’ thinking procedures in the heat of the moment and shows how nurses’ control their “feeling” and the set of the contextual determinants. Six theoretical propositions derived from the findings. During the patient’s examination and the clinical reasoning process, nurses adopt a particular “cognitive – emotional”posture of knowing and reflective thinking. This posture has an impact on the control of the nurse’s feeling andof the nature of what she felt and on the decision type. Depending of her posture, nurses will take into account her “feeling” or not. A negative emotion stops the decision making process. Intuition involves the search of additional fact or clues or clinical signs. The cognitive uncertainty induces a specific inquiry. The nurses’ “feeling’’ empirically characterize is an intuition, an emotion, an uncertainty.

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[pt] O objetivo desta pesquisa é projetar serviços da propedêutica clínica considerando o uso da tecnologia de visualização tridimensional como linguagem e fonte de dados para apoiar o raciocínio das decisões clínicas. Visando projetar esse serviço, avaliamos o potencial de algumas tecnologias de visualização tridimensional que poderiam ser úteis para apoiar a propedêutica: visualização de modelos em ambientes virtuais (imersão em Realidade Virtual ); projeção de modelos tridimensionais na realidade visualizados por smartphones (Realidade Aumentada); modelos impressos em 3D. Optamos por projetar um produto que seria o objeto de investigação aprofundada nesta pesquisa: um ambiente virtual para a visualização de casos clínicos reais por meio de óculos de realidade aumentada. Para realizar esta pesquisa um artefato para a visualização de casos clínicos reais por meio de Realidade Virtual (RV) e Realidade Aumentada (RA) foi projetado. O artefacto foi nomeado como ProVis3D e foi desenvolvido para que os médicos assistentes visualizassem, de forma tridimensional, imagens médicas em posição anatômica, mantendo as relações espaciais entre órgãos e vasos de forma fidedigna, para o que é proposto como precisão pelo método, e correspondendo a sua posição no mundo real, ou seja, como estas estão dispostas no interior do corpo humano. Além de poderem ser visualizadas, há possibilidade de interação com as imagens, simulando a percepção táctil, e de produzir sua movimentação: tocar em órgãos segmentados, vasos e vísceras, separar estas estruturas, aumentar seu tamanho e fazer a rotação do objeto em torno de seu eixo. Uma avaliação empírica foi realizada nesta pesquisa, na perspectiva epistemológica-metodológica projetiva Design Science Research (DSR), utilizando como metodologia projetando diferentes casos, com cinco unidades de análise (cada médico convidado para usar o artefato da pesquisa consiste em uma unidade de análise nesta pesquisa). A abordagem foi observacional e interpretativa, com a finalidade de compreender e refletir sobre o comportamento do médico, especialmente a sua tomada de decisão, quando utiliza o artefato desenvolvido nesta pesquisa. Foram projetadas diferentes cenas para possibilitar a observação das experiências dos usuários do ProVis3D (médicos especialistas e não especialistas) ao visualizar imagens médicas em contextos anatômicos reais (reconstrução 3D a partir de exames de tomografia computadorizada e modelos 3D coloridos com todas as estruturas nas suas posições reais) e ao interagir com essas imagens por meio de Realidade Aumentada. A cena virtual consiste em uma imagem tridimensional dinâmica, que pode ser manipulada para apoiar um cirurgião no seu planejamento cirúrgico ou apoiar um radiologista a complementar seu laudo na estação de trabalho (workstation). Os médicos visualizam a cena inicialmente em RV e posteriormente em RA. Duas questões foram elaboradas para o estudo: 1) Será que o artefato realmente possibilita obter informação de valor para a tomada de decisão clínica?; 2) Será que essa tecnologia de visualização realmente cria uma linguagem que possibilita aos médicos produzirem novos conhecimentos? A partir desse estudo, foi demonstrado que artefato ProVis3D tem potencial para apoiar a decisão clínica e que a tecnologia interativa de visualização tridimensional, em Realidade Aumentada, cria uma linguagem, faz os médicos conversarem de um modo diferente, sobre coisas que não estão habituados, possibilitando aos médicos produzirem novos conhecimentos. / [en] The objective of this research is to design a clinical propaedeutic services considering the use of three-dimensional visualization technology as a language and data source to support the reasoning of clinical decisions. In order to design this service, we evaluated the potential of some three-dimensional visualization technologies that could be useful to support the propaedeutics: visualization of models in virtual environments (immersion in Virtual Reality); projection of three-dimensional models in reality viewed by smartphones (Augmented Reality); 3D printed models. We opt to design a product that should be the object of further investigation in this research: a virtual environment for viewing real clinical cases through augmented reality glasses. In order to accomplish this research, an artifact for visualization of real clinical cases through Virtual Reality (VR) and Augmented Reality (AR) was designed The artifact was named as ProVis3D and was designed for assisting physicians to view medical images in an anatomical position and three-dimensional manner, maintaining spatial relationships between organs and vessels reliably as corresponding to their position in the real world and arranged within the human body. Besides being able to be visualized, there is a possibility for interact with the images, simulating the tactile perception, and producing its movement: touching segmented organs, vessels and viscera, separating these structures, increasing their size and rotating the object around them. its axis. An empirical evaluation was performed in this research, in the projective epistemological-methodological perspective Design Science Research (DSR), designing different cases with five units of analysis (each physician invited to use the research artifact consists of one unit of analysis in this research). The approach was observational and interpretative, with the purpose of understanding and reflecting on the physician s behavior, especially his decision making, when using the artifact developed in this research. Different scenes have been designed in order to observe experiences on ProVis3D s users (medical specialists and non-specialists) when viewing medical images in real anatomical contexts (3D reconstruction from CT scans and full-color 3D models with all structures in place) and interacting with these images through augmented reality. The virtual scene consists of a dynamic three-dimensional image that can be manipulated to support a surgeon on his surgical planning or support a radiologist to complement his workstation report. Doctors view the scene initially in RV and later in RA. Two questions were elaborated for the study: 1) Does the artifact really make it possible to obtain valuable information for clinical decision making? 2) Does this visualization technology really create a language that enables doctors to produce new knowledge? It has been demonstrated that ProVis3D artifact has the potential to support clinical decision making and that the augmented reality interactive three-dimensional visualization technology creates a language; it makes doctors talk differently about things they are not used to, enabling doctors to produce new knowledge.