Medical training for breaking bad news : review of the literature

Nos últimos anos, diretrizes para a comunicação médica de más notícias aos pacientes foram publicadas. Treinamentos para esta tarefa passaram a ser incluídos nos currículos de graduação, especialização e educação médica continuada. O objetivo desta revisão foi avaliar as evidências existentes na literatura sobre a eficácia destes treinamentos. Apenas sete estudos controlados, quatro dos quais randomizados, foram encontrados. Quatro deles indicam melhora dos aprendizes que foram treinados. Estes achados mostram que o treinamento em comunicação de más notícias pode ser eficaz para médicos e estudantes, mas há importantes limitações que impedem conclusões definitivas. Estas limitações são discutidas.Guidelines for communicating bad news to patients have been published and training programs for this task have been included in graduate and post-graduate medical courses. The aim of this review was to evaluate evidence_ of the efficacy of these trainings in the medical literature. Only seven controlled trials, four of them randomized, were found. Four for them showed improvement in communication skills in the trained apprentices. These findings suggest that training undergraduate and post-graduate doctors in the skills for communicating bad news may be beneficial but there are important limitations to reach a definitive conclusion. These limitations are discussed

Uma leitura semiótica das multidões

A semiotic reading of the multitude aims to problematize the functions of the incommensurable in semiosis. This involves questioning the problems of immanence, the rule of mediation that characterizes the contemporary semiotic thought and deconstruction of identities operated by queer theories. Therefore, methodologically, (1) we present the concepts of multitude developed by Charles Sanders Peirce, Antonio Negri and Michael Hardt; (2) we discuss the descriptive character of Peirce’s phaneroscopic categories to propose the Zeroness as the condition and immanence of all semiosis; (3) we identify the double side – virtual and mediated – of the singularity and (4) we show how the singularity, which is a potentiality, gives rise to identities in semiosis. It is the inseparable feature of singularity, identity and beliefs/habits that allows this article to report false dichotomies and affirm perspectivism as a fundamental horizon for semiotic studies of the multitude.Uma leitura semiótica das multidões tem o objetivo de problematizar as funções do incomensurável na semiose. Tal problematização envolve os problemas da imanência, do primado da mediação que caracteriza o pensamento semiótico contemporâneo e da desconstrução das identidades operada pelas teorias queer. Para tanto, metodologicamente, (1) apresentamos os conceitos de multidão desenvolvidos por Charles Sanders Peirce, Antônio Negri e Michael Hardt; (2) discutimos o caráter descritivo das categorias faneroscópicas de Peirce para propor a Zeroidade como condição e imanência de toda a semiose; (3) identificamos a dupla face – virtual e mediada – da singularidade e (4) demonstramos de que maneira a singularidade, que é uma potência, dá lugar na semiose a identidades. É o caráter indissociável da singularidade, da identidade e das crenças/hábitos que permite a este artigo denunciar falsas dicotomias e afirmar o perspectivismo como horizonte fundamental para os estudos semióticos das multidões

CD47 expression is decreased in hematopoietic progenitor cells in patients with myelofibrosis

Myelofibrosis (MF) is characterized by increased circulating hematopoietic progenitor cells (HPCs), abnormal cytokine levels, and the survival advantage of neoplastic progenitors over their normal counterparts, which leads to progressive disappearance of polyclonal hematopoiesis. CD47 is a surface glycoprotein with many functions, such as acting as a phagocytosis inhibitor of the expressing cell, that is increased in normal hematopoietic stem and progenitor cells mobilized into the blood and several human cancer-initiating cells, such as in acute myeloid leukemia. We compared CD47 expression in hematopoietic stem and progenitor cells of patients with MF and controls and found it to be decreased in progenitors of MF. Exposure of control HPCs to the cytokines transforming growth factor β and stromal-derived factor 1, which are important regulators of hematopoietic stem cell cycling and are overexpressed in patients with MF, did not modulate CD47 expression

High frequency of mutation G377S in Brazilian type 3 Gaucher disease patients

Gaucher disease (GD), the most prevalent lysosome storage disorder, presents an autosomal recessive mode of inheritance. It is a paradigm for therapeutic intervention in medical genetics due to the existence of effective enzyme replacement therapy. We report here the analysis of GD in 262 unrelated Brazilian patients, carried out in order to establish the frequency of the most common mutations and to provide prognostic information based on genotype-phenotype correlations. Among 247 type 1 GD patients, mutation N370S was detected in 47% of all the alleles, but N370S/N370S homozygosity was found in only 10% of the patients, a much lower frequency than expected, suggesting that most individuals presenting this genotype may not receive medical attention. Recombinant alleles were detected at a high frequency: 44% of the chromosomes bearing mutation L444P had other mutations derived from the pseudogene sequence, present in 25% of patients. Three neuronopathic type 2 patients were homozygous for L444P, all presenting additional mutations (E326K or recombinant alleles) that probably lead to the more severe phenotypes. Six children, classified as type 1 GD patients, had a L444P/L444P genotype, showing that neuronopathic symptoms may only manifest later in life. This would indicate the need for a higher treatment dose during enzyme replacement therapy. Finally, mutation G377S was present in 4 homozygous type 1 patients and also in compound heterozygosity in 5 (42%) type 3 patients. These findings indicate that G377S cannot be unambiguously classified as mild and suggest an allele-dose effect for this mutation.Univ São Paulo, Inst Biociencias, Dept Genet & Biol Evolut, BR-05508900 São Paulo, SP, BrazilHosp Evangel Londrina, Londrina, PR, BrazilHosp Base Distrito Fed, Brasilia, DF, BrazilUniv Fed Estado São Paulo, Escola Paulista Med, Dept Pediat, São Paulo, BrazilHEMORIO, Serv Hemoterapia, Rio de Janeiro, RJ, BrazilSanta Casa São Paulo, Fac Ciencias Med, Serv Hemato Oncol, São Paulo, SP, BrazilUniv Fed Estado São Paulo, Escola Paulista Med, Dept Pediat, São Paulo, BrazilWeb of Scienc

14-weeks combined exercise epigenetically modulated 118 genes of menopausal women with prediabetes

Background: Pre-diabetes precedes Diabetes Mellitus (DM) disease and is a critical period for hyperglycemia treatment, especially for menopausal women, considering all metabolic alterations due to hormonal changes. Recently, the literature has demonstrated the role of physical exercise in epigenetic reprogramming to modulate the gene expression patterns of metabolic conditions, such as hyperglycemia, and prevent DM development. In the present study, we hypothesized that physical exercise training could modify the epigenetic patterns of women with poor glycemic control. Methods: 48 post-menopause women aged 60.3 ± 4.5 years were divided according to their fasting blood glucose levels into two groups: Prediabetes Group, PG (n=24), and Normal Glucose Group, NGG (n=24). All participants performed 14 weeks of physical exercise three times a week. The Infinium Methylation EPIC BeadChip measured the participants’ Different Methylated Regions (DMRs). Results: Before the intervention, the PG group had 12 DMRs compared to NGG. After the intervention, five DMRs remained different. Interestingly, when comparing the PG group before and after training, 118 DMRs were found. The enrichment analysis revealed that the genes were related to different biological functions such as energy metabolism, cell differentiation, and tumor suppression. Conclusion: Physical exercise is a relevant alternative in treating hyperglycemia and preventing DM in post-menopause women with poor glycemic control

A aventura crítica da semiótica

The critical adventure of semiotics courses through the main theses about semiotics and communication that have been discussed during the first stage of the research Critical Semiotics: Towards a theory of materialities in communication. In it, the Semiotics and Communication Cultures Research Group (GPESC) discussed the potentialities and limits of a communicational perspective not only based on the founding works of semiotic research (Saussure, Peirce) and developed in its structuralist models (Jakobson, Barthes, Hjelmslev, Lotman), but also revisited by ideas that deconstructed structuralism through the postulates of this very structuralism (Derrida, Kristeva, Deleuze, Guattari). The paper presents this suggestion by means of ten deconstructions related to concepts and theoretical problems which are key to the debate around the materialities of communication: semiotics, communication, materialities, presence, phenomenon, representamen, mediums, sign and significant, structure and system. In so doing, it suggests a move from materialities towards the immanence of a micropolitical and post- human communication.A aventura crítica da semiótica percorre as principais teses sobre a semiótica e a comunicação conforme trabalhadas na primeira etapa da pesquisa Semiótica Crítica, denominada Por uma teoria das materialidades na comunicação. Nela, o Grupo de Pesquisa Semiótica e Culturas da Comunicação procurou discutir as potencialidades e limites de uma perspectiva comunicacional não somente fundamentada nos trabalhos fundadores da semiótica (Saussure, Peirce) e desenvolvida em seus modelos estruturalistas (como em Jakobson, Barthes, Hjelmslev e Lotman), mas também revisitada pelos textos que operaram uma desconstrução do estruturalismo pelo interior dos postulados deste próprio estruturalismo (Derrida, Kristeva, Deleuze, Guattari). O artigo apresenta esta proposta pelos modos como a pesquisa trabalhou com dez desconstruções ligadas a conceitos e problemas teóricos centrais ao debate das materialidades da comunicação: semiótica, comunicação, materialidades, presença, fenômeno, representâmen, meios, signo e significante, estrutura e sistema, sugerindo uma passagem das materialidades à imanência de uma comunicação micropolítica e pós-humana

A aventura crítica da semiótica

A aventura crítica da semiótica percorre as principais teses sobre a semiótica e a comunicação conforme trabalhadas na primeira etapa da pesquisa Semiótica Crítica, denominada Por uma teoria das materialidades na comunicação. Nela, o Grupo de Pesquisa Semiótica e Culturas da Comunicação procurou discutir as potencialidades e limites de uma perspectiva comunicacional não somente fundamentada nos trabalhos fundadores da semiótica (Saussure, Peirce) e desenvolvida em seus modelos estruturalistas (como em Jakobson, Barthes, Hjelmslev e Lotman), mas também revisitada pelos textos que operaram uma desconstrução do estruturalismo pelo interior dos postulados deste próprio estruturalismo (Derrida, Kristeva, Deleuze, Guattari). O artigo apresenta esta proposta pelos modos como a pesquisa trabalhou com dez desconstruções ligadas a conceitos e problemas teóricos centrais ao debate das materialidades da comunicação: semiótica, comunicação, materialidades, presença, fenômeno, representâmen, meios, signo e significante, estrutura e sistema, sugerindo uma passagem das materialidades à imanência de uma comunicação micropolítica e póshumana.The critical adventure of semiotics courses through the main theses about semiotics and communication that have been discussed during the first stage of the research Critical Semiotics: Towards a theory of materialities in communication. In it, the Semiotics and Communication Cultures Research Group (GPESC) discussed the potentialities and limits of a communicational perspective not only based on the founding works of semiotic research (Saussure, Peirce) and developed in its structuralist models (Jakobson, Barthes, Hjelmslev, Lotman), but also revisited by ideas that deconstructed structuralism through the postulates of this very structuralism (Derrida, Kristeva, Deleuze, Guattari). The paper presents this suggestion by means of ten deconstructions related to concepts and theoretical problems which are key to the debate around the materialities of communication: semiotics, communication, materialities, presence, phenomenon, representamen, mediums, sign and significant, structure and system. In so doing, it suggests a move from materialities towards the immanence of a micropolitical and posthuman communication

Problemas e perspectivas do tratamento da Leucemia Mielóide Crônica no Brasil Problems and perspectives for the treatment of Chronic Myeloid Leukemia in Brazil

O autor discute as limitações enfrentadas pelos centros de onco-hematologia nacionais na condução de pacientes com Leucemia Mielóide Crônica e os problemas relacionados à implementação, custeio e avaliação de resultados dos programas de tratamento para esta enfermidade.This article discusses the limitations which Brazilian hematology-oncology centers face when conducting treatment programs for Chronic Myeloid Leukemia and the problems concerning their implementation, funding and quality assessment by National Health Organization