As emoções do médico e as implicações para a prática clínica

O objetivo deste artigo foi investigar as emoções do médico e as implicações para a prática clínica. Utilizou-se o método misto, avaliando, na fase quantitativa, trinta médicos com atuação em consultório. Para a fase qualitativa, foram escolhidos quatro médicos para o estudo de caso. Os resultados mostraram que médicos mais velhos, com mais tempo de formação, que ficam mais tempo em consulta com o paciente sentiram-se mais impactados diante dos estímulos emocionais; e os que trabalham mais horas semanais no consultório perceberam os estímulos de forma menos prazerosa. Esses dados foram confirmados pelos agrupamentos dos quatro clusters. Efetuou-se a análise de caso com um representante de cada cluster. Os resultados revelaram que as emoções podem influenciar atitudes e percepções do médico na relação com o paciente

Sol-gel derived mesoporous Pt and Cr-doped WO(3) thin films: the role played by mesoporosity and metal doping in enhancing the gas sensing properties

Mesoporous Cr or Pt-doped WO(3) thin films to be employed as ammonia gas sensors were prepared by a fast one-step sol-gel procedure, based on the use of triblock copolymer as templating agent. The obtained films were constituted by aggregates of interconnected WO(3) nanocrystals (20-50 nm) separated by mesopores with dimensions ranging between 2 and 15 nm. The doping metals, Pt and Cr, resulted differently hosted in the WO(3) mesoporous matrix. Chromium is homogeneously dispersed in the oxide matrix, mainly as Cr(III) and Cr(V) centers, as revealed by EPR spectroscopy; instead platinum segregated as Pt (0) nanoparticles (4 nm) mainly included inside the WO(3) nanocrystals. The semiconductor layers containing Pt nanoclusters revealed, upon exposure to NH(3), remarkable electrical responses, much higher than Cr-doped and undoped layers, particularly at low ammonia concentration (6.2 ppm). This behavior was attributed to the presence of Pt nanoparticles segregated inside the semiconductor matrix, which act as catalysts of the N-H bond cleavage, decreasing the activation barrier in the ammonia dissociation. The role of the mesoporous structure in influencing the chemisorption and the gas diffusion in the WO(3) matrix appeared less decisive than the electronic differences between the two examined doping metals. The overall results suggest that a careful combination between mesoporous architecture and metal doping can really promote the electrical response of WO(3) toward ammonia

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Respostas Emocionais de Médicos aos Estímulos Afetivos do International Affective Picture System (IAPS)

RESUMO As emoções dos médicos têm um papel importante na relação com o paciente, pois podem interferir em suas atitudes, percepções e nos processos de julgamento e decisão. O objetivo desta pesquisa foi analisar a resposta emocional dos médicos aos estímulos do International Affective Picture System (IAPS). Este estudo utilizou o método quantitativo e avaliou 30 médicos, homens e mulheres de diversas especialidades, que dedicassem parte (ou a totalidade) de seu tempo ao atendimento clínico no consultório, que tivessem no mínimo dois anos de experiência após a conclusão da residência médica e que atuassem em medicina convencional (clínica médica). Os instrumentos utilizados na análise foram: o questionário sociodemográfico, para análise das variáveis; o IAPS, composto por imagens afetivas capazes de induzir estados emocionais; e o Self-Assessment Manikin (SAM), para classificação das respostas emocionais por meio de duas escalas: prazer e alerta. Os resultados mostraram que, quanto à percepção emocional, não houve diferença entre os resultados da amostra e da população geral, mas houve diferença na relação com as variáveis sociodemográficas – idade, tempo de formado, tempo médio de atendimento (consulta) e horas semanais dedicadas ao trabalho no consultório –, concluindo-se que médicos mais velhos, com mais tempo de formados e que ficam mais tempo em consulta com o paciente se sentiram mais impactados diante dos estímulos emocionais do que os médicos mais jovens, com menos tempo de formados e que ficam menos com o paciente em consulta. Os resultados também mostraram que os médicos que dedicam mais horas semanais ao trabalho no consultório perceberam os estímulos de forma menos prazerosa que os médicos que trabalham menos tempo no consultório e que dividem seu tempo com outras atividades. São necessárias novas pesquisas e estudos para o aprofundamento do tema das emoções e de sua influência na prática médica, considerando amostras maiores, em contextos distintos e novas variáveis

O discurso médico sobre as emoções vivenciadas na interação com o paciente: contribuições para a prática clínica

O estudo das emoções na prática clínica expõe sua influência na relação médico-paciente. Este artigo apresenta os resultados de uma pesquisa qualitativa cujo objetivo foi explorar o discurso dos médicos sobre as próprias emoções no atendimento a pacientes. Das entrevistas com oito médicos foram extraídos os seguintes temas de análise: função apostólica e o entendimento da emoção; defesas e estratégias perante as emoções; e a companhia de investimento mútuo: frustração e consequências. Os médicos demonstraram pouca percepção da influência das emoções sobre a própria atuação, apesar de terem relatado situações nas quais foram afetados por elas. Revelaram sofrimento em razão da dificuldade de elaborar conteúdos emocionais, usando distanciamento afetivo como um mecanismo de defesa. Conclui-se que a gestão emocional por parte do médico maximiza recursos na interação com o paciente, lançando novas perspectivas para a atuação médica

Hydrothermal N-doped TiO2: Explaining photocatalytic properties by electronic and magnetic identification of N active sites

N-doped TiO2 nanocrystals with high photoactivity in the visible range, were successfully synthesized by hydrothermal method, followed by thermal annealing at different temperatures (350–600 8C), in order to allow differential nitrogen diffusion into the TiO2 lattice. Optical and magnetic properties, studied by diffuse reflectance spectroscopy, electron paramagnetic resonance and X-ray photoelectron spectroscopy analysis, revealed that TiO2 was effectively doped. The thermal treatment induces insertion of nitrogen into TiO2 lattice in the form of nitride anion NÀ, detected as N by EPR, whose ionic character varies with the temperature of annealing. The amount of N increases till 450 8C, then it decreases. Similar trend was observed for the photomineralization of phenol under visible light irradiation (l > 385 nm): the photoactivity of N-doped samples becomes maximum for N–TiO2 annealed at 450 8C. The overall results suggest that the efficacy of the catalyst depends on the ability of NÀ centers to trap photogenerated holes. This effect lowers the rate of electron–hole recombination and allows the N (NÀ + h+) center acts as strong oxidizing agent

Hydrothermal N-doped TiO2: Explaining photocatalytic properties by electronic and magnetic identification of N active sites

N-doped TiO2 nanocrystals with high photoactivity in the visible range, were successfully synthesized by hydrothermal method, followed by thermal annealing at different temperatures (350–600 8C), in order to allow differential nitrogen diffusion into the TiO2 lattice. Optical and magnetic properties, studied by diffuse reflectance spectroscopy, electron paramagnetic resonance and X-ray photoelectron spectroscopy analysis, revealed that TiO2 was effectively doped. The thermal treatment induces insertion of nitrogen into TiO2 lattice in the form of nitride anion NÀ, detected as N by EPR, whose ionic character varies with the temperature of annealing. The amount of N increases till 450 8C, then it decreases. Similar trend was observed for the photomineralization of phenol under visible light irradiation (l > 385 nm): the photoactivity of N-doped samples becomes maximum for N–TiO2 annealed at 450 8C. The overall results suggest that the efficacy of the catalyst depends on the ability of NÀ centers to trap photogenerated holes. This effect lowers the rate of electron–hole recombination and allows the N (NÀ + h+) center acts as strong oxidizing agent

Photogenerated Defects in Shape-Controlled TiO2 Anatase Nanocrystals: A Probe To Evaluate the Role of Crystal Facets in Photocatalytic Processes

The promising properties of anatase TiO2 nanocrystals exposing specific surfaces have been investigated in depth both theoretically and experimentally. However, a clear assessment of the role of the crystal faces in photocatalytic processes is still under debate. In order to clarify this issue, we have comprehensively explored the properties of the photogenerated defects and in particular their dependence on the exposed crystal faces in shape-controlled anatase. Nanocrystals were synthesized by solvothermal reaction of titanium butoxide in the presence of oleic acid and oleylamine as morphology-directing agents, and their photocatalytic performances were evaluated in the phenol mineralization in aqueous media, using O2 as the oxidizing agent. The charge-trapping centers, Ti3+, O–, and O2–, formed by UV irradiation of the catalyst were detected by electron spin resonance, and their abundance and reactivity were related to the exposed crystal faces and to the photoefficiency of the nanocrystals. In vacuum conditions, the concentration of trapped holes (O– centers) increases with increasing {001} surface area and photoactivity, while the amount of Ti3+ centers increases with the specific surface area of {101} facets, and the highest value occurs for the sample with the worst photooxidative efficacy. These results suggest that {001} surfaces can be considered essentially as oxidation sites with a key role in the photoxidation, while {101} surfaces provide reductive sites which do not directly assist the oxidative processes. Photoexcitation experiments in O2 atmosphere led to the formation of Ti4+–O2– oxidant species mainly located on {101} faces, confirming the indirect contribution of these surfaces to the photooxidative processes. Although this work focuses on the properties of TiO2, we expect that the presented quantitative investigation may provide a new methodological tool for a more effective evaluation of the role of metal oxide crystal faces in photocatalytic processes.Depto. de Ingeniería Química y de MaterialesFac. de Ciencias QuímicasTRUEpu