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Objetivo: Buscamos demonstrar a necessidade de superação do “desafio kelseniano” referente à pretensa impossibilidade de racionalidade na interpretação e aplicação do Direito. Procuramos questionar o modelo kelseniano de ciência para a área jurídica e investigar se há uma objetividade no uso de “bons argumentos” capaz de impor um maior padrão de racionalidade aos operadores jurídicos brasileiro no momento da tomada de decisão. Metodologia: Partimos de uma pesquisa jurídica mais tradicional (embora não dogmática), baseada em uma resenha bibliográfica crítica de doutrina nacional e estrangeira. Compreendemos a ciência jurídica como uma ciência de ação que deve oferecer caminhos teóricos viáveis para a tomada de decisões e a solução de problemas concretos. Resultados: Concluímos que a ideia de Kelsen sobre a interpretação do Direito é resultado do seu conceito positivista de ciência, baseado na comprovação empírica das ciências exatas. A sua distinção rígida entre juízos de fato e juízes de valor (inacessíveis para o conhecimento científico) e afirmação da prevalência da vontade sobre a racionalidade no ato de interpretar/aplicar uma lei entram em conflito com o dever constitucional de fundamentação racional das decisões judiciais. Contribuições: Levantamos argumentos contra uma visão relativista da interpretação do Direito, que contribui para a imprevisibilidade das decisões judiciais. Esclarecemos diferentes aspectos da teoria de Kelsen que versam sobre a interpretação e aplicação da lei que são pouco discutidas na academia do Direito brasileiro.

This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students’ mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.

Abstract The objective of this study is to better understand the tensions involved in the fear of making an error due to the harm and risk this would pose to those involved. This is a qualitative study based on the narratives of the experiences lived by ten acting physicians in the state of São Paulo, Brazil. The concept and characterization of errors were discussed, as well as the fear of making an error, the near misses or error in itself, how to deal with errors and what to do to avoid them. The analysis indicates an excessive pressure in the medical profession for error-free practices, with a well-established physician-patient relationship to facilitate the management of medical errors. The error occurs but the lack of information and discussion often leads to its concealment due to fear of possible judgment by society or peers. The establishment of programs that encourage appropriate medical conduct in the event of an error requires coherent answers for humanization in Brazilian medical science.

Introduction: This article discusses how Brazilian physicians think about medical errors and the consequences on their professional careers. A retrospective study with a qualitative approach based on the professional experience of Brazilian physicians who work in a private hospital in Sao Paulo, Brazil. Materials and methods: The participants were twenty Brazilian physicians, including ten without medical errors and ten with medical errors. In-depth interviews were conducted with the physicians, and content analysis was conducted based on the phenomenological method. Results: No significant difference between the two groups was found. Both groups indicated that there is no error-free practice and that educational and health institutions offer no specific training for what to do when an error occurs. Physicians believe that they should not let themselves be influenced by society’s judgment of a physician who commits an error or by the medical error concept. The Brazilian media and society tend to blame physicians for their errors. The availability of a service or an institution that supports physicians who have committed a medical error is important because these professionals do not feel supported when an error occurs and feel that they require mental health support to face the ethical and civil proceedings. Well-established doctor-patient relationships can promote the well-being of medical practitioners. Conclusion: It is necessary to implement training and institutional practices that specify conduct conducive to improving Brazilian medical practice.

BACKGROUND: Several irregular red blood cell alloantibodies, produced by alloimmunization of antigens in transfusions or pregnancies, have clinical importance because they cause hemolysis in the fetus and newborn and in transfused patients. OBJECTIVE: a prospective analysis of patients treated by the surgical and clinical emergency services of Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (HC/UFTM), Brazil was performed to correlate alloimmunization to clinical and epidemiological data. METHODS: Blood samples of 143 patients with initial negative antibody screening were collected at intervals for up to 15 months after the transfusion of packed red blood cells. Samples were submitted to irregular antibody testing and, when positive, to the identification and serial titration of alloantibodies. The Fisher Exact test and Odds Ratio were employed to compare proportions. RESULTS: Fifteen (10.49%) patients produced antibodies within six months of transfusion. However, for 60% of these individuals, the titers decreased and disappeared by 15 months after transfusion. Anti-K antibodies and alloantibodies against antigens of the Rh system were the most common; the highest titer was 1:32 (anti-K). There was an evident correlation with the number of transfusions. CONCLUSIONS: Given the high incidence of clinically important red blood cell alloantibodies in patients transfused in surgical and clinical emergency services, we suggest that phenotyping and pre-transfusion compatibilization for C, c, E, e (Rh system) and K (Kell system) antigens should be extended to all patients with programmed surgeries or acute clinical events that do not need emergency transfusions.OBJETIVO: Vários aloanticorpos irregulares antieritrocitários, produzidos por sensibilizações a antígenos estranhos durante gestações ou transfusões, possuem importância clínica por provocarem hemólise no feto ou recém-nascido e/ou no receptor de sangue. Diante disso, fizemos uma análise prospectiva exclusiva de pacientes atendidos nos serviços de emergência clínica e cirúrgica, correlacionando as aloimunizações aos dados clínicos e epidemiológicos. MÉTODOS: Amostras sanguíneas de 143 pacientes, com pesquisa inicial de anticorpos negativa, foram coletadas até 15 meses após transfusões de concentrados de hemácias (CH), submetidas a Pesquisas de Anticorpos Irregulares (PAI) e, quando o resultado fosse positivo, à identificação e titulação seriada do(s) aloanticorpo(s). Para comparar proporções, foi empregado Teste Exato de Fisher e Odds Ratio. RESULTADOS: Dos pacientes estudados, 15 (10,49%) produziram aloanticorpos em um período de seis meses, com o título decaindo e negativando até 15 meses em 60% dos aloimunizados. Os aloanticorpos anti-K e os dirigidos contra antígenos do sistema Rh foram os mais frequente, o maior título foi de 1:32 (anti-K) e houve evidente correlação com o número de transfusões. CONCLUSÃO: Diante da alta ocorrência de aloanticorpos antieritrocitários de importância clínica em indivíduos transfundidos em serviço de emergência clínica e cirúrgica, propomos estender a fenotipagem e compatibilização pré-transfusional para os antígenos C, c, E, e (sistema Rh) e K (sistema Kell) para todos os pacientes com cirurgias programadas e/ou com eventos clínicos agudos que não necessitem de transfusões emergenciais.