In modern warfare, civilian populations may find themselves under immediate personal danger with very little warning. While there are ways to minimize this danger, there is a paucity of literature discussing this modern dilemma, and it is therefore important to try to address these situations in advance both logistically and ethically. Discussion of this case includes several relevant ethical principles.

In modern warfare, civilian populations may find themselves under immediate personal danger with very little warning. While there are ways to minimize this danger, there is a paucity of literature discussing this modern dilemma, and it is therefore important to try to address these situations in advance both logistically and ethically. Discussion of this case includes several relevant ethical principles.

Next SectionObjectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy. Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth (...) grade level, interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests. Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit. Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required. Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392. (shrink)

Les technologies contemporaines de l’image, telles que les ultrasons, l’endoscopie, et autres IRM et scanners, transforment l’image de notre corps. Dans cet article, cette transformation est particulièrement mise en lumière à partir d’une œuvre de Mona Hatoum intitulée “ Corps étranger ”. Cette œuvre d’art consiste en une projection vidéo d’images endoscopiques de l’intérieur du corps de l’artiste. On dit souvent qu’il est impossible de s’identifier soi-même à partir de ce type d’images dans la mesure où elles sont difficilement reconnaissables (...) comme des parties de son corps propre. Ou encore qu’elles n’appartiennent pas à l’image narcissique du corps. A l’aide d’une analyse phénoménologique et psychanalytique, l’auteur s’attache ici au contraire à montrer que de telles images fournissent une image affective de notre corps propre et qu’à travers elles il devient possible d’affronter l’étrangeté de celui-ci. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be the (...) acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

L’ouvrage de Vassiliki Lalagianni Voyages des femmes en Orient, paru en Grèce aux éditions Roes, opère l’endoscopie du tournant du xixe siècle, par l’étude transversale du voyage et du regard que portent sur l’Orient les femmes occidentales. Peu d’ouvrages ont été consacrés aux femmes voyageuses françaises et francophones. La majorité des études ne concerne que les Britanniques (Jane Robinson, Wayward Women: A Guide to Women Travelers,1990 ; M. Polk and M. Tiegreen, Women of Discovery: A Cel...

The interior of the body is an alien landscape, the frontiers of which we are continually expanding. Technological developments have allowed us to see more and more of what lies beneath the skin. Starting with the violently erotic public spectacle of dissection in amphitheatres, through X-ray and endoscopy, to other current and future technologies that work towards the yet to be realized ideal (or myth) of a truly non-invasive but microscopically detailed depiction of the human body. This opening up (...) of the human interior to our gaze is not exclusively a medical phenomenon. It is an exploration that has been shared by scientists, artists and entertainers, variously reappropriating imagery and technologies of seeing. Each new invasive technology brings with it the somewhat naïve belief that it can excavate the essence of the subject, their passions, motivations and faults, their ‘souls’ for lack of a better word. Yet while an X-ray can certainly not tell us anything of the subject’s personality, as we delve deeper we discover more about our chemical and electrical natures, encouraging the perception that our consciousness is the ‘sum of our parts’. However, as technologies have become more sophisticated, there has been an increasing tendency to present the body in segments, detached from their surrounding structures. A certain objectification and distancing that occurs when we view the flesh laid open. How do we engage with these views culturally, and how do they influence how we view others and ourselves? In this article I grapple with notions of a mutating body that we are actively in the process of changing in the context of my own and others’ visual practice, with particular emphasis on making the mediated nature of these images visible. I will engage in a celebratory but critical discussion of others’ and mine. (shrink)

The novel COVID-19 infection has spread all over the world and is still generating a lot of issues at different levels. There is a lack of control in disease early diagnosis and rapid evolution, which impacts both the medical and the economic system. Young gastroenterologists should adapt to overcome current difficulties and continue their life and general training. This is a multi-center national study, which aims to assess the general perspective of young gastroenterologists from six university centers in Romania regarding (...) their current training and the psychological effect the pandemic has on their life and job. An online survey with 58 items was distributed using Google Forms, and quality of life and anxiety were assessed. The validated instruments 15D and endler multidimensional anxiety scales were used. All analyses were performed using SPSS 25. Of the 174 gastroenterologists approached, 96 responded. A majority of the respondents were residents in gastroenterology, and 40.6% were male. The pandemic influenced the number of examined patients as well as young gastroenterologists’ endoscopy training. Health-related quality of life was negatively associated with the level of anxiety generated by the cognitive component of anxiety as a state, the new and ambiguity of the state, and how threatened the respondent felt. The level of anxiety was moderate, and no difference was found between the physicians working in a designated hospital or not. General caution should be considered for young gastroenterologists’ training, and continuous observation should be done to ensure better mental health on the current evolution. These findings would need to be verified in larger-sample studies and in different types of specialties. (shrink)