[The school doctorand suspected child abuse : towards good practice recommendations in the child's interest]. / Le médecin scolaire et la suspicion de maltraitance à enfant : vers des recommandations de bonnes pratiques dans l'intérêt de l'enfant.

Child maltreatment, including all forms of mal¬treatment, remains a major public health problem in high-income countries. Healthcare professionals only contribute to a small proportion of reports. In French-speaking Belgium, almost 100 % of school-aged children are regularly submitted to periodical school health visits. The school health doctor is well placed to recognize neglected or abused children. Based on international good practice recommendations, this paper proposes means for the detection and management of child abuse in the context of school medicine.

La maltraitance infantile représente, dans les pays à haut niveau de revenus, un «problème de santé publique majeur¼, 5 à 10 % des enfants étant concernés, toutes formes de maltraitances confondues. Les professionnels de santé contribuent à une petite proportion seulement des signale¬ments. En Fédération Wallonie-Bruxelles, les bilans de santé scolaire périodiques couvrant près de 100 % des enfants sco¬larisés, le médecin scolaire est bien placé pour le repérage d'enfants exposés à une négligence de soins et/ou à de mauvais traitements. Se basant sur des recommandations de bonne pratique publiées, cet article propose des pistes d'action per¬mettant de contribuer à un meilleur repérage et à une prise en charge adaptée de la maltraitance infantile dans le cadre de la médecine scolaire.

[Anatomical contents in the Rorschach test: comparison between a population of nurses and a control group]. / Les contenus anatomiques au test de Rorschach : comparaison des réponses de sujets infirmiers à une population contrôle.

INTRODUCTION: The study of answer contents to a Rorschach test leads to numerous debates and controversies. From a pragmatic point of view, the recurrent question is to understand the meaning of a content (or its repetition) in a protocol. From a discursive and perceptive point of view, it is hazardous to give an interpretation other than descriptive and contextual. Indeed, no single interpretative theory or analysis method is able to determine with certainty and rigor a strict correlation between people's psychological functioning and the contents they perceive. METHODS: In this empirical context, we studied the "anatomy" answers (frequencies and formal qualities) in a population of nurses (n=38) matched with a control group (non-medical subjects, n=38). The Rorschach test was administrated according to the recommendations of the Integrated System. RESULTS: The average of An+Xy answers was clearly and significantly higher in the nurse population (3.58) than in the control group (0.89) and than in the three comparative norms that we selected (from 0.96 to 1.83). Concerning the formal quality, the repeated-measures analysis of variance showed a significant interaction effect: although subjects in the control group gave a similar number of ordinary, unusual and minus forms for An+Xy answers, the nurses gave more erroneous (minus) forms (1.79) than unusual forms (1.21) and finally than ordinary forms (0.58). DISCUSSION: Two hypotheses may be suggested in order to explain our findings. On one hand, it is highly probable that our results are linked to the everyday body confrontation in a nurse's job. On the other hand, we suggest that by giving An+Xy answers, nurses tend to reveal some idiosyncratic characteristics in order to show their own identity. Indeed, our nurse subjects were selected because of their job, and so they complied with the social identity that was implicitly expected. This is congruent with the complex functioning in social reality: in a social group, people will not verbalize all of their perceptions; they will preferentially verbalize perceptions that define their social identity. Conversely, if some perceptions do not comply with the subject's identity, these perceptions will be less frequently verbalized, despite the fact that they were perceived. Concerning the second main finding, the inadequate formal quality of answers given by nurses emphasizes a visual misrepresentation conditioning due to one's job. This effect is interesting from a psychological point of view because it suggests that this tendency to perceive more anatomical contents arises to the detriment of the "reality". Finally, our findings allowed us to suggest the hypothesis of the role of identity in answer contents to a Rorschach test according to the context, and to formulate some recommendations about the content use in the Rorschach interpretation.

Influence of 2D and 3D view on performance and time estimation in minimal invasive surgery.

This study aimed to evaluate the impact of two-dimensional (2D) and three-dimensional (3D) images on time performance and time estimation during a surgical motor task. A total of 60 subjects without any surgical experience (nurses) and 20 expert surgeons performed a fine surgical task with a new laparoscopic technology (da Vinci robotic system). The 80 subjects were divided into two groups, one using 3D view option and the other using 2D view option. We measured time performance and asked subjects to verbally estimate their time performance. Our results showed faster performance in 3D than in 2D view for novice subjects while the performance in 2D and 3D was similar in the expert group. We obtained a significant interaction between time performance and time evaluation: in 2D condition, all subjects accurately estimated their time performance while they overestimated it in the 3D condition. Our results emphasise the role of 3D in improving performance and the contradictory feeling about time evaluation in 2D and 3D. This finding is discussed in regard with the retrospective paradigm and suggests that 2D and 3D images are differently processed and memorised.

Error detection: a study in anaesthesia.

Although error has been shown as the main cause of accidents in complex systems, little attention has been paid to error detection. However, reducing the consequences of error depends largely on error detection. The goal of this paper is to synthesize the existing scientific knowledge on error detection, mostly based on studies conducted in laboratory or self reporting and to further knowledge through the analysis of a corpus of cases collected in a complex system, anaesthesia. By doing this, this paper is better able to describe how this knowledge can be used to improve understanding of error detection modes. An anaesthesia accident reporting system developed and organized at two Belgian University Hospitals was used in order to collect information about the error detection patterns. Results show that detection of errors principally occurred through the standard check (routine monitoring of the environment). Significant relationships were found between the type of error and the error detection mode, and between the type of error and the training level of the anaesthetist who committed the error.

Impact of 2D and 3D vision on performance of novice subjects using da Vinci robotic system.

PURPOSE OF THE STUDY: The aim of this study was to evaluate the impact of 3D and 2D vision on performance of novice subjects using da Vinci robotic system. METHODS: 224 nurses without any surgical experience were divided into two groups and executed a motor task with the robotic system in 2D for one group and with the robotic system in 3D for the other group. Time to perform the task was recorded. RESULTS: Our data showed significant better time performance in 3D view (24.67 +/- 11.2) than in 2D view (40.26 +/- 17.49, P < 0.001). CONCLUSIONS: Our findings emphasized the advantage of 3D vision over 2D view in performing surgical task, encouraging the development of efficient and less expensive 3D systems in order to improve the accuracy of surgical gesture, the resident training and the operating time.

Canine T-cell lymphomas: a morphological, immunological, and clinical study of 46 new cases.

The aim of this study is to report 46 new cases of canine T-cell lymphomas among a series of 140 lymphomas studied by immunophenotyping (incidence 32.8%). According to the updated Kiel classification adapted to the canine species, 13 were classified as low-grade and 33 as high-grade lymphomas. Among the low-grade lymphomas, five were small clear-cell lymphomas, three were pleomorphic small-cell lymphomas, and five mycosis fungoides. Among the high-grade cases, there were 11 pleomorphic mixed-, small-, and large-cell lymphomas, 6 pleomorphic large-cell lymphomas, 11 lymphoblastic lymphomas, and 5 unclassifiable high-grade plasmacytoid lymphomas. The cytohistologic features were highly suggestive of a T-cell phenotype on the basis of cell morphology (irregular nuclei and clear cytoplasms) (30/46 cases), a T-cell zone pattern, and the presence of hyperplastic postcapillary venules (22/46 cases). All 46 cases were CD3+ CD79a-, and among 34 cases investigated for CD4 and CD8 expression, 13 were CD4+CD8-, 13 were CD8+CD4-, and 8 were CD4CD8 double positive or double negative. The pleomorphic mixed lymphomas were mainly CD4+CD8- (6/7) and the lymphoblastic lymphomas were double positive or double negative (6/8). The main clinical, hematologic, and biochemical features were generalized (28/46) or regional lymphadenopathy (16/46), hepatosplenomegaly (15/46), extranodal involvement (11/46), mediastinal mass (9/46), and leukemia (8/46), which were mainly present in cases of lymphoblastic lymphomas and hypercalcemia (16/46).

Atypical forms of canine leishmaniosis.

Canine leishmaniosis is a common disease in the Mediterranean area, but sporadic cases in dogs having travelled through endemic regions are also reported. The disease's evolution is usually chronic and symptoms are either non-specific (fever, weight loss, lethargy, enlarged lymph nodes), dermatological, renal or ocular. The purpose of this article is to review the literature and to describe our own experience of certain atypical forms of canine leishmaniosis. These include specific skin lesions, monoclonal gammopathy, renal failure (without any other signs), chronic colitis, haemostatic problems and disorders of the cardiovascular, respiratory and musculo-skeletal systems.