Feasibility and Safety of Active Physiotherapy in the Intensive Care Unit for Intubated Patients with Malignancy.

OBJECTIVES: Physiotherapy leads to improvements in critically ill patients who receive mechanical ventilation. However, cancer patients have not been included in previous studies on this subject. This study explored the feasibility and safety of physiotherapy in the intensive care unit for patients with malignancy. DESIGN: Observational prospective single-centre study, comparing cancer and control patients. PATIENTS: All consecutive patients admitted to the intensive care unit who needed invasive mechanical ventilation for more than 2 days with no contraindication to physiotherapy were included in the study. METHODS: The main outcome was the proportion of physiotherapy sessions at the prescribed level in each group. RESULTS: A total of 60 patients were included within 1 year. A total of 576 days were screened for physiotherapy sessions and 367 physiotherapy-days were analysed (137 days for control patients and 230 days for cancer patients). The ratio of physiotherapy sessions performed/prescribed did not differ between groups: 0.78 (0.47-1) in the control group vs 0.69 (0.6-1) in the cancer group (odds ratio 1.18 (IC95% 0.74-1.89); p = 0.23). A sensitivity analysis including patient effect as random variable confirmed those results (odds ratio 1.16 (0.56-2.38), p = 0.69). Adverse events occurred with the same frequency in cancer patients and non-cancer patients. CONCLUSION: Physiotherapy in cancer patients who require intubation is feasible and safe. However, only two-thirds of prescribed physiotherapy sessions were performed. Studies are warranted to explore the barriers to physiotherapy in the intensive care unit setting.

Treating strangeness: Medicine and human dignity at the time of COVID-19.

The concomitance of a migratory wave and the hospital crisis once again raises the question of the care that the French healthcare system is able to provide to migrants. On the occasion of SFFEM's 19th annual day, we present a synthesis of the research work that has been communicated at that time. Firstly, we will discuss how doctors have been able to overcome strangeness to revive the notion of hospitality according to Levinas; secondly, we will discuss how the hospital is departing from its mission of institutional hospitality because of administrative injunctions; thirdly, we will discuss how ethnomedicine gives us keys to open up to other cultural norms; fourthly, we will see the inadequacy that exists between rights of access to medical care and their effectiveness; finally, the conclusion of Xavier Emmanuelli, founder of the social ambulance service, will remind us how much the values of the French Republic call us to the notion of care and openness to otherness.

[Assisted suicide: When the legislative cannot take the place of the existential]. / Le suicide assisté : quand le législatif ne peut se substituer à l'existentiel.

The question of the meaning of life arises as much for the young as for the old, as soon as they experience their finitude through some experience of death. To explore the issue in retrospect, let's look at death and suicide at different scales. If we were to compare suicide to one of the cell deaths, perhaps we would compare it to apoptosis as performed by the cell itself. At the animal level, survival follows the law of the strongest or the most intelligent. On an anthropological scale, civilizations survive in the illusion of their immortality. It is certain that suicide is a most intimate act and can, in this respect, be considered an act of freedom since it relieves the body's perception of any physical law, perception being abolished by death. The fascination for suicide is based on an intellectual exploration, a search for an absolute answer in opposition to all relativism, which paradoxically will take shape in annihilation. In times of pandemic and confinement, humanity experiences its finiteness. Confinement has re-installed a sense of loneliness in a society that lives on constant hyper-communication. In this text, the author demonstrates that suicide must be avoided because it is nonsense for both the individual and the community. Thus, living with disability as well as old age should be valued more highly, and public health policies against the causes leading to suicide should become state priorities. Finally, far from pathologizing suicide, the question of legally recognizing the right to (unassisted) suicide for those who commit it must be asked.

How nonverbal communication shapes the doctor-patient relationship: from paternalism to the ethics of care in oncology.

The purpose of this research, led in the wake of years of pressure to reject paternalism, was to study whether controlled practice of nonverbal communication by doctors inheres a continued risk of paternalistic attitudes in oncology clinic interviews (chosen to illustrate the doctor-patient relationship). This study involved qualitative descriptive research based on interview observations and questionnaires and mobilized recognized theory borrowed from sociology and anthropology. We found that the legislative framework governing the doctor-patient relationship has simply shifted the paternalism issue from verbal communication over to a new area that doctors have not yet mastered and patients have not yet understood, i.e., nonverbal communication. This study shows that all the laws framing the doctor-patient relationship can be circumvented, and that by controlling nonverbal communication, the doctor can fall back into paternalism. The rejection of paternalism therefore needs to lead to an appropriate reading of the patient's story, which in ethical terms can only happen if hospital structures are made non-paternalizing by design, if doctors learn to understand the patient's different chronemic timeframe, and if doctors committedly engage in the Hippocratic Oath codified through the ethics of care.