Libras na formação médica: possibilidade de quebra da barreira comunicativa e melhora na relação médico-paciente surdo

INTRODUÇÃO: Mudanças curriculares para a graduação em Medicina incluem o desenvolvimento de habilidades de comunicação na graduação do aluno. O conhecimento da Língua Brasileira de Sinais (Libras) pelo médico visa romper barreiras comunicativas com os pacientes surdos e é um bom método para se obter escuta qualificada e excelência do cuidado em saúde. OBJETIVO: Avaliar o contingente de médicos recém-formados pela Universidade Federal de Minas Gerais (UFMG) que domina a Libras. MÉTODOS: Entrevista aplicada aos alunos do 12° período do curso de Medicina da UFMG, utilizando um questionário online na plataforma Google Forms. RESULTADOS: Foram entrevistados 102 alunos. Nenhum deles tinha domínio sobre a língua e apenas 7% possuíam alguma habilidade. Desses, o que os motivaram a aprender Libras foi a proximidade com deficientes auditivos, o interesse em romper a barreira comunicativa entre profissionais de saúde e surdos ou a curiosidade. O meio utilizado para aprender Libras foi variado. Um quarto dos alunos não sabia da existência da disciplina optativa “Fundamentos de Libras” disponibilizada pela UFMG e, dentre os que sabiam, apenas três fizeram a disciplina. Para atender um deficiente auditivo, mais da metade dos alunos disseram que escreveria, desenharia e/ou faria mímicas, e 8 deles não saberiam o que fazer. Dentre os que possuem alguma habilidade na Libras, todos utilizariam a língua mesmo que de maneira limitada. Quase 80% dos entrevistados acreditam que é importante para a formação médica saber se comunicar com surdos por meio da Libras. CONCLUSÃO: Existe uma barreira comunicativa entre os estudantes de medicina recém-formados da UFMG e os surdos que utilizam a Libras. Tal estudo mostra, portanto, a noção da grandiosidade desse impasse, indicando a necessidade de iniciativas que preconizem pesquisas que possam divulgar as situações problemas e, posteriormente, tentar resolvê-las.INTRODUCTION: Curricular changes for Medical graduation includes the development of communication skills of the medical student. The knowledge of the Brazilian Sign Language (Libras) by the physician aims to break communicative barriers with deaf patients and is a good method to obtain qualified listening and excellence in health care. OBJECTIVE: To evaluate the contingent of doctors recently graduated from the Federal University of Minas Gerais (UFMG) who dominate Libras. METHODS: Interview applied to the students of the 12th period of the Medical School of UFMG, using an online questionnaire on the Google Forms platform. RESULTS: A total of 102 students were interviewed. None of them had mastery over the language and only 7% had some skill. Of those, what motivated them to learn Libras was the proximity to deaf people, the interest on breaking the communicative barrier between health professionals and the deaf or the curiosity. The way used to learn Libras was varied. A quarter of students did not know about the discipline “Fundamentals of the Brasilian Sign Language (Libras)” offered by UFMG and, among those who knew, only three of them took the discipline. In order to attend a deaf patient, more than half of the students said they would write, design, and/or mimic, and 8 of them did not know what they would do. Among those with some Libras ability, all would use the language even in a limited way. Almost 80% of the interviewed believe that it is important for the medical education to know how to communicate with the deaf through Libras. CONCLUSION: There is a communicative barrier between the doctors recently graduated from UFMG and deaf who use Libras. The study shows, a notion of the grandiosity of this impasse, indicating a need for initiatives that advocate research that reveal the problematic situations, and then, try to solve them

More is not always better: The impact of value co‐creation fit on B2B and B2C customer satisfaction

Organizations increasingly rely on customer involvement in the value creation process (i.e., co-creation) to enhance customer satisfaction and differentiate themselves from competitors. While past research has largely indicated that more co-creation is beneficial, some have suggested yet not empirically validated that excess co-creation may negatively impact customers. Applying the service-dominant logic, two studies (B2B and B2C customers) offer insight into the appropriate levels of the co-production and value-in-use dimensions of co-creation. For both B2B and B2C customers, polynomial regression and surface plot analyses indicate an inverted U-shaped relationship between value co-creation and satisfaction, establishing that more co-creation is beneficial only up to a point. As such, we inform managers of factors that can cause the relationship between co-creation and satisfaction to peak and then turn negative. Further, customer expertise and process enjoyment moderate this relationship for B2C (but not B2B) customers, thereby offering ways to mitigate the negative effects of excess co-creation for end-customers. The studies also highlight the importance of value co-creation “fit” between the customer\u27s expected and experienced levels of co-creation. Interestingly, positive misfit (i.e., excess co-creation) retains a stronger negative influence on customer satisfaction than negative misfit (i.e., insufficient co-creation) for both B2B and B2C customers

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

BackgroundSparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis.MethodsPROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850.FindingsBetween Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals.InterpretationOver 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function

Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial

Background: Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin and angiotensin receptor antagonist being examined in an ongoing phase 3 trial in adults with IgA nephropathy. We report the prespecified interim analysis of the primary proteinuria efficacy endpoint, and safety. Methods: PROTECT is an international, randomised, double-blind, active-controlled study, being conducted in 134 clinical practice sites in 18 countries. The study examines sparsentan versus irbesartan in adults (aged ≥18 years) with biopsy-proven IgA nephropathy and proteinuria of 1·0 g/day or higher despite maximised renin-angiotensin system inhibitor treatment for at least 12 weeks. Participants were randomly assigned in a 1:1 ratio to receive sparsentan 400 mg once daily or irbesartan 300 mg once daily, stratified by estimated glomerular filtration rate at screening (30 to 1·75 g/day). The primary efficacy endpoint was change from baseline to week 36 in urine protein-creatinine ratio based on a 24-h urine sample, assessed using mixed model repeated measures. Treatment-emergent adverse events (TEAEs) were safety endpoints. All endpoints were examined in all participants who received at least one dose of randomised treatment. The study is ongoing and is registered with ClinicalTrials.gov, NCT03762850. Findings: Between Dec 20, 2018, and May 26, 2021, 404 participants were randomly assigned to sparsentan (n=202) or irbesartan (n=202) and received treatment. At week 36, the geometric least squares mean percent change from baseline in urine protein-creatinine ratio was statistically significantly greater in the sparsentan group (-49·8%) than the irbesartan group (-15·1%), resulting in a between-group relative reduction of 41% (least squares mean ratio=0·59; 95% CI 0·51-0·69; p<0·0001). TEAEs with sparsentan were similar to irbesartan. There were no cases of severe oedema, heart failure, hepatotoxicity, or oedema-related discontinuations. Bodyweight changes from baseline were not different between the sparsentan and irbesartan groups. Interpretation: Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan. Funding: Travere Therapeutics

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

Background Sparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis. Methods PROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850. Findings Between Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals. Interpretation Over 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function.</p