Triple rational dimension of red doctor’s culture / 中国医学伦理学

The red doctor’s culture is not only the spiritual force that inspired soldiers of red doctor’s to overcome difficulties during the revolutionary war， but also the rational sublimation of adapting Marxism to the Chinese context and the needs of our times at the level of theoretical construction. From the perspective of philosophical rationality， the red doctor’s culture highlights the triple dimensions of value rationality， communicative rationality， and practical rationality. In terms of value rationality， the red doctor’s culture manifests the value picture with dignity and happiness as the purpose. As far as communicative rationality is concerned， it conspicuous the communication picture characterized by dialogue and negotiation， as well as harmony and accommodation. With regard to practical rationality， it shows the practice picture with the aim of respecting the truth and advocating practice， exploring and innovating. The triple rational dimensions jointly interpret the logical core and era scene of the red doctor’s culture in the dimensions of value care， subject concern， and realistic solicitude.

A conexão entre a intencionalidade e a consciência: um estudo filosófico / La conexión entre la intencionalidad y la conciencia: un estudio filosófico / The connection between intentionality and consciousness: a philosophical study

Este artigo aborda a relação entre consciência e intencionalidade, argumentando que essas duas características fundamentais da mente estão intrinsecamente entrelaçadas. A partir da perspectiva da Teoria da Intencionalidade Fenomenal (TIF), exploramos como a intencionalidade afenomenal (não-fenomenal) depende da consciência para sua adequada representação pelos sujeitos, destacando a visão de Dennett sobre uma intencionalidade original e fenomenal. Em seguida, analisamos o argumento transcendental proposto por Searle para o livre arbítrio, que revelou insights valiosos sobre como a racionalidade pode ser experimentada. Ao unir os pressupostos da TIF com a análise do livre arbítrio, sustentamos que a experiência da liberdade de agir está baseada em razões e é mediada pela consciência. Concluímos que a intencionalidade e a consciência não estão separadas como entidades isoladas, mas são interdependentes e complementares. Portanto, compreender essas facetas como elementos integrados é essencial para uma compreensão abrangente da mente. Este estudo contribui para o avanço teórico e conceitual no campo da psicologia da consciência e fornece um arcabouço para pesquisas futuras sobre a interação entre consciência e intencionalidade.(AU)

This paper discusses the relationship between consciousness and intentionality, arguing that these two fundamental features of mind are intrinsically interwoven. From the perspective of the Phenomenal Intentionality Theory (PIT), we explore how phenomenal intentionality depends on consciousness for its proper representation by subjects, highlighting Dennett's view on original phenomenal intentionality. Then, we analyze Searle's transcendental argument for free will, which has revealed valuable insights into how rationality can be experienced. By combining PIT's assumptions with the analysis of free will, we argue that the experience of freedom to act is based on reasons and is mediated by consciousness. We conclude that consciousness and intentionality are not separate as isolated entities, but are interdependent and complementary. Therefore, understanding these facets as integrated elements is essential for a comprehensive understanding of mind. This study contributes to the theoretical and conceptual advancement in the field of consciousness psychology and provides a framework for future research on the interaction between consciousness and intentionality.(AU)

Este artículo aborda la relación entre conciencia e intencionalidad, argumentando que estas dos características fundamentales de la mente están intrínsecamente entrelazadas. Desde la perspectiva de la Teoría de la Intencionalidad Fenomenal (TIF), exploramos cómo la intencionalidad afenomenal (no fenomenal) depende de la conciencia para su adecuada representación por los sujetos, destacando la visión de Dennett sobre una intencionalidad original y fenomenal. A continuación, analizamos el argumento trascendental propuesto por Searle para el libre albedrío, que ha revelado conocimientos valiosos sobre cómo la racionalidad puede ser experimentada. Al unir los presupuestos de la TIF con el análisis del libre albedrío, sostenemos que la experiencia de la libertad de actuar está basada en razones y está mediada por la conciencia. Concluimos que la intencionalidad y la conciencia no están separadas como entidades aisladas, sino que son interdependientes y complementarias. Por lo tanto, comprender estas facetas como elementos integrados es esencial para una comprensión integral de la mente. Este estudio contribuye al avance teórico y conceptual en el campo de la psicología de la conciencia y proporciona un marco para futuras investigaciones sobre la interacción entre conciencia e intencionalidad.(AU)

O laboratório de leitura como "campo" para o cultivo e a manutenção da saúde mental no contexto do neoliberalismo / The reading laboratory as a "field" for the cultivation and maintenance of mental health in the context of neoliberalism / Le laboratoire de lecture comme "terrain" pour cultiver et de maintenir la santé mentale dans le contexte du néolibéralisme / El laboratorio de lectura como "campo" para el cultivo y mantenimiento de la salud mental en el contexto del neoliberalismo

Este artigo objetiva refletir sobre o adoecimento psíquico do sujeito no contexto do neoliberalismo, que consiste em força estruturante (Bourdieu) que age sobre a sua subjetividade, desenhando-a a partir de uma lógica empresarial, pautada pela máxima produtividade, racionalidade cartesiana e desvalorização dos afetos, de que resulta o adoecimento mental e sofrimento psíquico desse sujeito. Para tanto, apresenta-se uma experiência com a leitura literária desenvolvida coletivamente por meio do Laboratório de Leitura como proposta de intervenção desmobilizadora dessas estruturas estruturantes.

Resumos This article aims to reflect on the psychic illness of the subject in the context of neoliberalism, which is a structuring force (Bourdieu) that acts on their subjectivity, drawing it from a business logic, guided by maximum productivity, Cartesian rationality and devaluation of affections, resulting in the mental illness and psychic suffering of this subject. To this end, an experience with literary reading developed collectively via the Reading Laboratory is presented as for na intervention to demobilize these structuring structures.

Cet article reflète sur la maladie psychique du sujet dans le contexte du néolibéralisme, une force structurante (Bourdieu) qui agit sur sa subjectivité, en la tirant d'une logique d'entreprise basée sur la productivité maximale, la rationalité cartésienne et la dévalorisation des affects, ce qui entraîne la maladie mentale et la souffrance psychique de ce sujet. Pour ce faire, une expérience de lecture littéraire développée collectivement à travers le Laboratoire de lecture est présentée comme une proposition d'intervention pour démobiliser ces structures structurantes.

Este artículo tiene como objetivo reflexionar sobre la enfermedad psíquica del sujeto en el contexto del neoliberalismo, que consiste en una fuerza estructurante (Bourdieu) que actúa sobre su subjetividad extrayéndola de una lógica empresarial, guiada por la máxima productividad, la racionalidad cartesiana y la desvalorización de los afectos, lo que tiene como resultado la enfermedad mental y el sufrimiento psíquico de este sujeto. Para ello, se presenta una experiencia con la lectura literaria desarrollada colectivamente mediante el Laboratorio de Lectura como propuesta de intervención desmovilizadora de estas estructuras estructurantes.

Evaluation of ?-blockers dosage regimen rationality in heart failure patients

Background: ?-Blockers are often associated with further cardiac function deterioration, ledding to them being often underused/underdosed by certain physicians in heart failure treatment, although they were seen to be beneficial in decreasing the rates of mortality and morbidity, duration of hospitalization in HFrEF patients, but data on their benefits in HFmEF and HFpEF patients is limited. Objective was to evaluate rationality of ?-blockers’ dosage regimen and its effectiveness in HF patients. Methods: 43 HF patients have been enrolled. Data were collected from the medication chart (dose, route, frequency); dosage regimen was evaluated and compared to that of ESC guidelines for HF treatment. Heart rates pre/post drug treatments, ejection fraction (at admission & post-discharge) were recorded; effectiveness was evaluated through heart rate control, reduction in: duration of hospitalization, rehospitalization and mortality rate. Post-discharge updates of the patients were obtained through out-patient consultation reports. Results: In All 43 patients dosage regimen of selected ?-Blockers was found to be rational and following the ESC guideline for HF treatment. 65% of patients spent not more than 5 days in the hospital, 16% Re-hospitalized for cardiovascular diseases, and death rate was 4%. Conclusions: The dosage regimen of selected ?-Blockers was found to be as per that of ESC-guidelines HF treatment. ?-Blockers have also been found to have reduced: hospitalization stay, frequency of rehospitalization, and death rate among patients under study.

"Conscience Epistemology" Based on "Loving-kindness Theory": The Basic Role of "Strengthening Conscience" in Moral Education / 中国医学伦理学

Based on the new ontology of the "loving-kindness theory", it is confirmed that the "conscience" of human beings (with internal natural law guidance and moral force) is "loving-kindness", which is the "needs/intrinsic driving force of life" as the "first cause" of human existence. It provides force for the realization of morality, yardstick of the natural necessity for moral judgment and practice, and value basis for virtue and norms. Therefore, "strengthening conscience", that is, recognizing, activating and strengthening conscience and its function and expression, is the foundation and key link of moral education. Its lack is the reason for the failure of "spiritual midwifery-style" or intellectual moral education. Revealing "conscience epistemology" with universal knowledge is the prerequisite of "strengthening conscience", and the fundamental field of moral education and moral philosophy that urgently needs to be explored. This paper revealed the "conscience epistemology" with universal knowledge, including that the precondition for revealing the "strengthening conscience" was to obscure or transcend "survival fear"; revealed the the appearance of conscience in terms of life rational emotions, personality, attitude to life, and behavior mode (i.e. "phase" and "different"); revealed the cognitive life rational pedigree of cognitive conscience (i.e. opening up human existence); revealed the principle of "strengthening conscience". Among them, all kinds of life rationality and life rational emotion are the unity of sensibility and reason, the unity of freedom and morality, and also with universality.

Epicurus’ View of Life and Death and Its Contemporary Enlightenment / 中国医学伦理学

Epicurus’ view of life and death is based on the atomism of naturalism and the epistemology of sensationalism in ancient Greek. He advocated that people should face death calmly, and separate death from the pain of feeling by explaining the true meaning of death to break people’s fear of death. He claimed that people should face desires with rational thinking and pursue a happy life. His view of life and death helped people to treat life and death rationally, alleviate death anxiety, make people actively face the difficulties in life, correctly identify desires and needs, and help individuals pursue a healthy and happy life.

Prospects and Suggestions for the Application of ChatGPT in Medical Ethics Education / 中国医学伦理学

ChatGPT represents the approaching singularity, which brings opportunity to medical ethics education, but is also constrained by issues such as unfairness, discrimination, and loss of autonomy caused by technological logic. This paper explored the intermediary relationship model of generative AI in medical ethics education, and analyzed the potential positive and negative values of this technology as a human creation, as well as the challenges that ChatGPT brings to medical ethics education. Based on this, suggestions are put for ward from the following four aspects. First, The role division and construction of different responsible subjects was explored based on the change in teacher-student relationship. Second, we shonld cultivate students’ ability to think and question. Third, the forward-looking responsibility was discussed based on the future development of intelligent education. Fourthly, from the perspective of technical logic, it presupposes the coexistence of human-machine dual subjects.

Value Rational Return of Medical Humanities Education under the Concept of People First / 中国医学伦理学

The concept of people first has important inspirations for the value rational return of medical humanities education in the new era. It is consistent with the educational value, curriculum attribute, and practical attribute of medical humanistic education, and puts forward new requirements for the value rational return of medical humanities education in terms of educational supply content, practical curriculum setting, educational development form, and educational effect evaluation. Medical colleges and universities should further adhere to the medical humanities education concept centered on people’s health, optimize the practice curriculum of medical humanistic education, innovate the practice platform of medical humanistic education, and construct a value evaluation mechanism of medical humanistic education, so as to promote the value rational return of medical humanities education under the concept of people first.

Technical Reflection and Ethical Care Based on Clinical Practice / 中国医学伦理学

While modern medical technology improves human health, it also changes people’s ethical ways of understanding life, weighing interests, planning for a good life, and building public order and good customs. Technical reflection and clinical evidence-based practice are highly complementary. On the one hand, the cognitive purport of clinical practice changes from "causality" to "correlation". On the other hand, technical reflection opens the review perspective of ethical care. Technical reflection helps medical professionals improve working methods through technical control and ethical care, promote the transition of clinical practice from "cognitive domain" to "ethical domain", and then respond to the basic questions of "what should be done" and "how should be done" in clinical practice.

Analysis and evaluation of the application of polymyxin B in inpatients based on clinical guidelines and consensuses / 中国药房

OBJECTIVE To evaluate the rationality of clinical application of polymyxin B in the inpatients of a third grade class A hospital，so as to provide evidence for the optimization of clinical scheme of the drug. METHODS A retrospective method was conducted on the electronic medical records of inpatients treated with Polymyxin B sulfate for injection from January 2020 to March 2022 to collect the basic information of patients， inpatient departments and time， infection diagnosis， results of pathogenic bacteria test， laboratory test indicators， usage and dosage， and combined medication，etc. Based on the drug instructions， according to relevant guidelines and consensus， the rationality， efficacy and safety of polymyxin B in inpatient were evaluated. RESULTS & CONCLUSIONS A total of 101 inpatients were included， respiratory system infection was the main cause （62.4%）. All patients had received the etiological examination， and the pathogen with the highest detection rate was carbapenem‑resistant Acinetobacter baumannii （40.6%）. One hundred patients were treated by intravenous drip， and 4 patients were treated by combination of aerosol inhalation or intrathecal injection； 99 patients were given the dose of 500 thousand units by continuous intravenous infusion， q12 h. Totally 51.5% of patients were treated for 7-14 days； and 77 patients were treated with other anti-Gram-negative drugs. There were unreasonable phenomena including too short time of medication （29.7%）， no combination of medication （23.8%）， and no indication of medication （17.8%）. The clinical effective rate of 101 patients treated with polymyxin B was 49.5%， and 16 patients （15.8%） had acute kidney injury during the treatment. Clinical pharmacists should actively participate in the clinical treatment of polymyxin B， formulate individualized treatment plans according to the guidelines/consensus and in combination with the patient’s condition and infection status to improve the rationality of clinical medication.

The rationality and surgical errors in countermeasures against difficult removal of screws / 中华创伤骨科杂志

Objective:To investigate the rationality and surgical errors in countermeasures against difficult removal of screws so as to provide reference for standardization of technical procedures.Methods:A retrospective study was conducted to analyze the data of 99 patients who had encountered difficult removal of screws in operative removal of internal fixation at Department of Orthopaedics, Wuxi NO.9 People's Hospital Affiliated to Suzhou University from January 2018 to May 2022. There were 62 males and 37 females with an average age of 38.8±14.7 years. Their internal fixation time ranged from 7 months to 11 years. The irrationality was defined as insufficient preoperative preparation or a countermeasure that failed to follow the surgical indications or scientific principles of minimal injury or priority of simplicity. A surgical error was defined as unnecessary injury, failed removal or complications related to operation. Cases of irrationality and surgical errors were analyzed to find associations between them.Results:The operative removal was successful in 92 cases and failed in 7 cases. Of the patients who experienced difficult removal of screws, irrationality was found in 26.3% (26/99) and a surgical error or errors occurred in 28.3% (28/99). In the patients with countermeasure irrationality, the incidence of surgical errors was 53.9% (14/26) while in those without countermeasure irrationality, the incidence of surgical errors was 19.2% (14/73), showing a statistically significant difference ( χ2=11.360, P<0.001). In the patients with surgical errors, the incidence of countermeasure irrationality was 64.3% (18/28) while in the patients without surgical errors, the incidence of countermeasure irrationality was and 11.3% (8/71), showing a statistically significant difference ( χ2=29.148, P<0.001). In the patients with failed removal, the rate of countermeasure irrationality was 85.71% (6/7) while in those with successful removal, the rate of countermeasure irrationality was 21.7% (20/92), showing a statistically significant difference ( χ2=13.748, P<0.001). Conclusions:Close relationships exist between countermeasure irrationality, surgical errors and failed removal. The higher proportion of countermeasure irrationality, the higher possibility of surgical errors. Therefore, following the rationality principle may avoid or reduce surgical errors in difficult removal of screws.

Survey on the awareness and application of radiation shielding specifications for γ-ray radiotherapy room / 中国职业医学

Objective: To investigate the implementation of GBZ/T 201.3-2014 Radiation Shielding Specification for Radiotherapy Room--Part 3: Radiotherapy Room of γ-ray Sources (hereinafter referred to GBZ/T 201.3-2014). Methods: A total of 129 personnels, who were involved in the approval and supervision of radiation diagnosis and treatment construction projects in 19 provincial administrative agencies, engaged in radiation protection testing and evaluation of γ-ray radiotherapy rooms in radiation health technology service institutions, and used GBZ/T 201.3-2014 in other institutions (environmental impact assessment, education and scientific research), were selected as the participants using a stratified random sampling method. A questionnaire survey was conducted to assess their awareness and application of the standard. Results: The participants' awareness of GBZ/T 201.3-2014 was ≥63.6%, but the training rate was only 9.1% to 50.0%. The familiarity with the various chapters of the standard was over 86.4%. And 42.6% of the participants reported using the standard at least once a year. Regarding the applicability of the standard, all of the participants believed that the standard meets the needs of approval, supervision, testing, or evaluation, and adapts to the updated development of radiotherapy equipment and technology. And 94.6% of the participants believed that the use of the standard could improve the level of protection design and management, and 92.2% believed that the standard was widely applied. Regarding the adequacy of the standard, 97.7% of the participants believed that the standard's reference for ambient dose equivalent rate was reasonable, while 34.1% believed that the standard needs revision. Conclusion: The participants are satisfied with the standard and believe its applicability. They have a good level of awareness of the standard, but there is a room for improvement in their familiarity with the shielding calculation related content of the standard. The promotion, training, and practicality of the standard need to be strengthened.

Emoción, subjetividad, memoria y salud mental / Emotion, subjectivity, memory and mental health

RESUMEN Se intenta esclarecer las diferentes estrategias que utilizan la psicología clínica y la psiquiatría para modificar esquemas emocionales y conductuales inadecuados, inadaptados o psicopatológicos. Se revisa la literatura científica, internacional y relevante en relación al tema, investigación original, narrativa y cualitativa, con componentes integradores, agregativos e interpretativos. Para la emocionalidad son fundamentales la respuesta fisiológica, tan vinculada a la genómica, y la vivencia de los sentimientos y pensamientos. Las que pueden considerarse como lógica y memoria afectivas de trabajo muestran que, por lo general, las preferencias e intenciones son las que deciden o determinan y la racionalidad la que explica. Gracias al rol de la estría terminal, la estructura subcortical amigdalina es capaz de desencadenar todo tipo de respuesta emocional. En síntesis, la verdad o certeza en entornos múltiples será solo una opinión y no algo incuestionable. La anatomofisiología, creencias, cultura y actitudes personales están interrelacionados y se influyen mutuamente de manera continua.

SUMMARY Clinical psychology and psychiatry use different strategies to modify inadequate, maladjusted or psychopathological emotional and behavioral schemas. This study is based on related relevant international scientific literature, an original narrative qualitative research with integrating, aggregational and interpretative components. The physiological response, so linked to genomics, and the experience of thoughts and feelings are fundamental for emotionality. Affective logic and work memory express well that preferences and intentions generally decide and then rationality, explains. Thanks to the role of terminal stria, the subcortical amygdala structure is able to trigger any type of emotional response. In short, truth or certainty in multiple environments will only be an opinion and not something unquestionable. The anatomophysiology, beliefs, culture and personal attitudes are interrelated and influence themselves mutually on a continuous basis.

Prescription auditing using the WHO drug prescribing indicators in a tertiary care hospital: An observational retrospective study

Background: Prescription auditing is an important tool to assess and evaluate the drug utilization pattern and rational use of medicines. A successful prescription audit is crucial for health care workers, patients, and the community to ensure that their patients receive the best possible treatment. The purpose of drug audit is to improve patients care and to avoid potential fatal errors. Aim and Objectives: This study has been conducted to evaluate and analyze existing prescription errors in tertiary care hospital of Rajasthan and their magnitude. Materials and Methods: A retrospective observational study was carried out in Jhalawar Medical College, a tertiary care hospital in Rajasthan. Around 1000 prescriptions were collected randomly from medical college pharmacies. Outpatient prescriptions from all the major clinical departments available at hospital pharmacies were analyzed using the WHO prescribing indicators. Information regarding the patient, doctor, drug, and legibility of the prescription were obtained. Results: In our study, we found that most common age group mentioning in prescriptions were 18� years (55.7%), most common gender are males (60.2%). Generic names were prescribed in all prescriptions (100%). Patient information was mentioned in 73.2% prescriptions. Warning signs were not mentioned in any prescription whereas 10.2% prescription mentioned medicines name in capital letter. Average number of medicines per prescription was 4.1. Prescription with drugs prescribed from essential drug list was 88%. Conclusions: In our study, we found many insufficiencies, lack of clarity and important instructions in different parts of prescriptions. There is immediate requirement of improvement in prescribing habits of doctors. Proper steps such as workshops, practical training, and continuing medical education should be needed to guide the physicians to promote rational prescription.

Prescription pattern and rationality of fixed dose combinations in a tertiary care hospital – Record-based cross-sectional study

Background: Fixed dose combinations (FDCs) are combinations of two or more active drugs in a single pharmaceutical formulation. The rationality of FDC is a controversial and challenging issue in today’s practice of medicine. Aims and Objectives: The aim of the study was to assess the prescription pattern and rationality of FDCs in a tertiary care hospital. Materials and Methods: This is a record-based cross-sectional study conducted in the Department of Pharmacology, Government Medical College, Thrissur. The data were collected from the case records of 183 patients admitted under various departments during the month of January 2019. The FDCs prescribed were listed and the prescription pattern was assessed. All the FDCs were evaluated for rationality with the help of a comprehensive seven-point criteria by Panda et al. The data were analyzed using Epi info 7. Descriptive statistics were used to analyze the data. Results: Out of 183 case records, 39.3% contained at least one FDC, 13.1% contained two FDCs, and 4.4% contained three FDCs. The different drug classes prescribed as FDCs include anti-infective drugs 45%, vitamins and minerals 33%, analgesics 9%, and miscellaneous drug combinations 13%. The most prescribed anti-infective drug FDC is amoxicillin with clavulanic acid combination (56%). In our study, 92.5% of the antibacterial FDCs prescribed were rational and 7.5% irrational. According to the World Health Organization rationality criteria, 62% of the FDCs prescribed were rational and 38% were irrational. Conclusion: The present study showed the increased use of FDCs in tertiary care teaching hospital and most of the FDCs prescribed were rational (62%).

A comparative quantitative evidence-based chronopharmacological efficacy research between metformin monotherapy and metformin combination therapy, and a systematic review and meta-analysis on the application rationalities of metformin pharmacotherapeutics

Background: This comparative efficacy quantification research between metformin monotherapy and metformin combination therapy, and the subsequent systematic review, along with a consecutive meta-analysis of the different as well as wide-ranged study literature on oral hypoglycemic application rationality of metformin pharmacotherapeutics were performed, for a better comprehension of multicenter maintenance of rational pharmacotherapeutic aspects in the regular antidiabetic mono- and combination therapies prescribed to the new Type II diabetic patients. Aim and Objective: This clinical research study was conducted with the objective for a comparative quantitative evidence-based chronopharmacological efficacy research between metformin monotherapy and metformin combination therapy, and a systematic review, along with an accompanying meta-analysis, on the application rationalities of metformin pharmacotherapeutics. Materials and Methods: In this comparative quantitative evidence-based chronopharmacological efficacy research study, 100 patients suffering from newly detected early moderate grade Type II diabetes mellitus, were allotted into Group A consisting of 50 patients and Group B consisting of 50 patients. The Group A patients were prescribed the anti-diabetic treatment of orally administered metformin 500 mg, to be taken once daily for a span of 30 days, as metformin 1st line (only) monotherapy. The Group B patients were prescribed an oral hypoglycemic drug other than metformin, as 1st line anti-diabetic treatment, for the 1st 30 days, and then these Group B patients were gradually transferred to oral metformin combination therapy with another oral hypoglycemic drug, as metformin 2nd line (only) combination therapy, for the next 30 days. The derived study findings of comparative percentage efficacy quantification were statistically analyzed, on the basis of comparison between both the deduced results, for obtaining the comparative quantitative evidence-based chronopharmacological efficacy between metformin monotherapy and metformin combination therapy. Systematic review as well as meta-analysis is clinical research methods, comprising of a detailed, systematic and interpretative method of collecting, assessing and synthesizing the various medical evidences, to elaborate the research solution to a well-defined research question, in the form of a well-structured qualitative research review as well as quantitative analytical interpretations. Results: In this study, it was derived that the evidence-based chronopharmacological comparative percentage efficacy quantification of anti-diabetic metformin treatment showed 53% of percentage efficacy, when metformin was administered as 1st line (only) monotherapy, and 47% of percentage efficacy, when metformin was administered as 2nd line (only) combination therapy, with other oral hypoglycaemic drugs, prescribed in diabetes mellitus type II treatment regimens. The systematic review as well as meta-analysis in this study deduced 2482 refined, and also relevant, medical research database records, from total 3211 medical research database records, with a comprehensive qualitative and quantitative research database analyses. Conclusions: In this study, it was concluded that there was a slightly greater pharmacological efficacy of metformin 1st line (only) monotherapy than metformin 2nd line (only) combination therapy. The systematic review as well as meta-analysis derived a refined and conclusive medical research analysis, which was qualitatively synthesised, along with quantitative interpretations, on the various application rationalities of metformin pharmacotherapeutics.

Comprensión Hermenéutica de una Ontologia del Presente en la Era Digital / Hermeneutic Understanding of an Ontology of the Present in the Digital Age / Compreensão Hermenêutica de uma Ontologia do Presente na Era Digital

Resumen EL presente como categoría filosófica, expresa un carácter conductual, que se asume como una actitud (ethos) frente a un mundo digital. Este "ethos" configura una relacionalidad entre Lo humano y La máquina, construye puentes de apertura (apertus) que consolida unidades de posibilidad existencial a través de prácticas que manifiestan, no una digitalización, sino, una digitalización, esto es, una praxis particular y singular que, en el marco digital, pretende comprender intencionalmente el campo existencial del ser humano en las lógicas digitales. Esta digitalización como práctica, configura, "el presente" que en el marco de lo digital se constituye en una racionalidad, una especie de capacidad que tienen los seres humanos de analizar a través de un ejercicio mental la realidad existencial de sí mismo y de su entorno.

Abstract The present as a philosophical category, expresses a behavioral character, which is assumed as an attitude (ethos) towards a digital world. This "ethos" configures a relationship between the human and the machine, builds bridges of opening (apertus) that consolidates units of existential possibility through practices that manifest, not a digitization, but a digitiza-tion, that is, a praxis particular and unique that, in the digital framework, intends to intentionally understand the existential field of the human being in digital logics. This digitaliza-tion as a practice configures "the present" that in the digital framework constitutes a rationality, a kind of capacity that human beings have to analyze through a mental exercise the existential reality of themselves and of your environment.

Resumo O presente como categoria filosófica expressa um caráter comportamental, que se assume como uma atitude (ethos) em relação a um mundo digital. Esse "ethos" configura uma relação entre o humano e a máquina, constrói pontes de abertura (apertus) que consolida unidades de possibilidade existencial por meio de práticas que manifestam, não uma digitalização, mas uma digitalização, ou seja, uma práxis particular e única que, no quadro digital, pretende compreender intencionalmente o campo existencial do ser humano nas lógicas digitais. Essa digitaliza-ção como prática configura "o presente" que no quadro digital constitui uma racionalidade, uma espécie de capacidade que os seres humanos têm de analisar por meio de um exercício mental a realidade existencial de si e de seu ambiente.

Racionalidad pugilistica y supremacismo médico-legal. Una controversia argumental sobre la violencia consensuada

Este artículo presenta una revisión crítica de algunos de los principales argumentos esgrimidos por detractores y defensores en el denominado debate sobre el boxeo. Se examinan las posturas planteadas por destacados representantes del activismo médico-legal a favor de la abolición total del boxeo y se confronta particularmente el mito de la naturaleza salvaje e irracional de dicho deporte. Se contrasta tal concepción con el abordaje etnográfico propuesto por Lois Wacquant y su mentor, Pierre Bourdieu, sobre la existencia de una racionalidad pugilística forjada en el habitus corporal del boxeador. Se recorren aspectos importantes del problema como es el hecho de que la Pedagogía, a través de la cual se enseña a boxear, dista de ser consciente, reflexiva, teorizadora e intelectualista (lo cual alimenta la apariencia de una supuesta ausencia de formación y cultivo de un saber que es eminentemente práctico). Asimismo, se muestra la dualidad de la argumentación médica al moverse sutilmente del plano epistémico al plano ético-moral y las implicaciones que tal opacidad arrastra. El objetivo del artículo no es cerrar la controversia en detrimento de las preocupaciones del sector médico-sanitario, sino mostrar la complejidad filosófica que le subyace.

Este artigo apresenta uma revisão crítica de alguns dos principais argumentos apresentados por adversários e apoiadores no chamado debate do boxe. Ela examina as posições apresentadas por destacados representantes do ativismo médico-legal em favor da abolição total do boxe e enfrenta em particular o mito da natureza selvagem e irracional do esporte. Esta concepção é contrastada com a abordagem etnográfica proposta por Lois Wacquant e seu mentor, Pierre Bourdieu, sobre a existência de uma racionalidade pugilística forjada no hábito corporal do boxeador. Aspectos importantes do problema são explorados, como o fato de que a pedagogia através da qual o boxe é ensinado está longe de ser consciente, reflexiva, teorizante e intelectual (o que alimenta a aparência de uma suposta ausência de treinamento e cultivo de um conhecimento que é eminentemente prático). Ela também mostra a dualidade da argumentação médica ao passar sutilmente do plano epistêmico para o plano ético-moral, e as implicações que tal opacidade implica. O objetivo do artigo não é fechar a controvérsia em detrimento das preocupações do setor médico-sanitário, mas mostrar a complexidade filosófica que lhe está subjacente.

This article presents a critical review of some of the main arguments put forward by detractors and defenders in the so-called boxing debate. It examines the positions put forward by prominent representatives of medico-legal activism in favor of the total abolition of boxing and particularly confronts the myth of the savage and irrational nature of the sport. This conception is contrasted with the ethnographic approach proposed by Lois Wacquant and his mentor, Pierre Bourdieu, on the existence of a pugilistic rationality forged in the boxer's bodily habitus. Important aspects of the problem are discussed, such as the fact that pedagogy, through which boxing is taught, is far from being conscious, reflective, theorizing and intellectualistic (which feeds the appearance of a supposed absence of training and cultivation of a knowledge that is eminently practical). It also shows the duality of medical argumentation by subtly moving from the epistemic plane to the ethical-moral plane and the implications that such opacity entails. The aim of the article is not to close the controversy to the detriment of the concerns of the medical-health sector, but to show the philosophical complexity that underlies it.

Racionalidad y sensibilidad ética en el cuidado enfermero al paciente internado en un hospital público peruano de Nivel II-2 / Rationality and ethical sensitivity in nursing care for patients admitted to a Peruvian public hospital of Level II-2

Introducción: En enfermería, la vivencia ética connota ser siempre afectivo-reflexiva, al ejercerse en contextos de fragilidad y vulnerabilidad de los pacientes, exigiendo a los profesionales del cuidado y la salud a actuar con tales criterios beneficiando a las personas cuidadas. Objetivo: Describir la racionalidad y sensibilidad ética en el cuidado de enfermería al paciente de un hospital público peruano de nivel II-2. Material y métodos: Se asumió el enfoque cualitativo, de tipo descriptivo bajo diseño de análisis hermenéutico. La muestra fue de 15 enfermeros, obtenido en muestreo no probabilístico por conveniencia, quienes trabajaron en el área de Medicina Interna del hospital público mencionado. Se recolectó la información mediante entrevista semiestructurada aplicada por medios digitales, previo consentimiento informado. Los datos se procesaron a través del análisis de contenido. Resultados: a) Disponibilidad y esfuerzo hacia un cuidado compasivo y solidario, b) Equilibrando deberes y afectos hacia el bien global del enfermo, c) Comprensión interactiva, confianza y buen trato hasta el final de la vida. Conclusión: Los resultados destacan la capacidad de la enfermera para aplicar la afectividad, la empatía, la comunicación afectiva, la mirada atenta y el contacto físico; así como la disponibilidad para oír e interpretar las necesidades, además de comprender la angustia, sufrimiento, miedos y dolor de la persona cuando está internada en un nosocomio.

Background: In nursing, the ethical experience connotes being always affective-reflexive, when exercised in contexts of fragility and vulnerability of patients, requiring care and health professionals to act with such criteria, benefiting the people cared for. Objective:To describe the rationality and ethical sensitivity in nursing care for patients in a level II-2 Peruvian public hospital. Material and methods: The qualitative, descriptive approach was assumed under hermeneutic analysis design. The sample consisted of 15 nurses, obtained through non-probabilistic convenience sampling, who worked in the Internal Medicine area of the aforementioned public hospital. Information was collected through a semi-structured interview applied by digital means, with prior informed consent. The data was processed through content analysis. Results: a) Availability and effort towards compassionate and supportive care, b) Balancing duties and affections towards the global good of the patient, c) Interactive understanding, trust and good treatment until the end of life. Conclusion: The results highlight the nurse's ability to apply affectivity, empathy, affective communication, attentive gaze and physical contact; as well as the availability to listen and interpret the needs, in addition to understanding the anguish, suffering, fears and pain of the person when they are admitted to a hospital.

Do racional desregramento de todos os sentidos de Rimbaud ao sentimento de racionalidade em James / From Rimbaud's rational derangement of all the senses to James' sentiment of rationality / Du raisonné dérèglement de tous les sens chez Rimbaud au sentiment de rationalité chez James / Del razonado desarreglo de todos los sentidos de Rimbaud al sentimiento de racionalidad en James

Resumo Este ensaio traz o método do racional desregramento de todos os sentidos, do poeta Arthur Rimbaud, como ponto de partida para uma reflexão sobre a relação entre razão e afeto e para um possível diálogo com a noção de sentimento de racionalidade, do psicólogo e filósofo William James, sob a perspectiva teórico-metodológica do construtivismo semiótico-cultural em psicologia. Aborda-se o experimento de inalação do óxido nitroso de James como uma experiência de desregramento dos sentidos que proporcionou a ele uma compreensão sobre a questão da unidade e da variedade, ajudando a enriquecer sua cosmovisão empirista e pluralista, em oposição ao racionalismo monista de Hegel.

Abstract This essay uses Rimbaud's rational derangement of all the senses as a starting point for its reflection on the relationship between reason and affection, and for possible dialogues with psychologist and philosopher William James' sentiment of rationality, from the perspective of semiotic-cultural constructivism in psychology. James' experiment of nitrous oxide inhalation is seen as an experience of derangement of the senses that gave him insight on the question of unity and variety, thus enriching his empiricist and pluralist worldview opposed to Hegel' s monistic rationalism.

Résumé Cet essai utilise le raisonné dérèglement de tous les sens de Arthur Rimbaud comme point de départ de sa réflexion sur la relation entre raison et l'affection, et des dialogues possibles avec le sentiment de rationalité du psychologue et philosophe William James, dans la perspective du constructivisme sémiotique-culturel en psychologie. L'expérience d'inhalation d'oxide nitreux de James est considérée comme une expérience du dérèglement des sens qui lui a donné un aperçu de la question de l'unité et de la variété, enrichissant ainsi sa vision empiriste et pluraliste du monde, opposée au rationalisme moniste de Hegel.

Resumen Este ensayo toma el método del racional desarreglo de todos los sentidos del poeta Arthur Rimbaud como punto de partida para una reflexión sobre la relación entre la razón y el afecto, y un posible diálogo con la noción del sentimiento de la racionalidad del psicólogo y filósofo William James, bajo la perspectiva teórico-metodológica del constructivismo semiótico-cultural en psicología. El experimento de la inhalación de óxido nitroso de James se aborda como una experiencia de desarreglo de los sentidos que le proporcionó una comprensión de la unidad y la variedad, contribuyendo a enriquecer su cosmovisión empirista y pluralista en oposición al racionalismo monista de Hegel.