Henri G. Colt

Facing an unprecedented surge of patient volumes and acuity, institutions around the globe called for volunteer healthcare workers to aid in the effort against COVID-19. Specifically being sought out are retirees. But retired healthcare workers are taking on significant risk to themselves in answering these calls. Aside from the risks that come from being on the frontlines of the epidemic, they are also at risk due to their age and the comorbidities that often accompany age. If, for current or future COVID efforts, we as a society will be so bold as to exhort a vulnerable population to take on further risk, we must use much care and attention in how we involve them in this effort. Herein we describe the multifaceted nature of the risks that retired healthcare workers are taking by entering the COVID-19 workforce as well as suggest ways in which we might take advantage of their medical skills and altruism yet while optimizing caution and safety.

Background: Assessment of competency in bronchoscopy has traditionally been undertaken in clinical settings, however, recent recognition of increased procedural complications and learner anxiety have led to interest in simulation-based competency assessment. The aim of this study was to determine if low-fidelity simulation-based assessment allows discrimination of competency based on prior experience between bronchoscopists. Methods: Forty-four participants were allocated to 3 groups based on prior bronchoscopic experience [novices (n=31) with no prior experience, intermediates (n=7) with prior experience of 5 to 10 bronchoscopies, and expert bronchoscopists (n=6) with minimum 200 prior bronchoscopies performed]. Participants performed bronchoscopy in a 3D-printed anatomic airway model and were assessed according to time required to navigate to a target bronchus. Bronchoscopic dexterity was measured using a modified version of the validated Bronchoscopy Skills and Tasks Assessment Tool. Results: Competency based on successful navigation to a target bronchus differed significantly between each group [experts, 12/12 (100%); intermediates, 9/14 (64%); novices, 19/62 (31%); PP<0.0.001). Conclusions: Multiple measures demonstrate that low-fidelity simulation-based assessment may reliably discriminate between different levels of skill in performing bronchoscopic navigation and airway inspection. Procedural dexterity of trainees may be assessed in a 0-risk simulation environment.

Background and Aims: It is generally accepted that patients prefer to be told the truth by their physicians; however, the practice of partial truth‐telling is frequent with an existing ‘norm of nondisclosure.’ Our primary objective was to determine what patients wanted to be told about their illness, and whether there might be differences between patients with either cancer or advanced chronic obstructive pulmonary disease (COPD). A second objective was to determine how these patients envisioned their participation, or lack thereof, in the treatment decision‐making process.Methods: Subjects were eligible for this prospective study if they were attending the oncology or pulmonary outpatient consultation services at the British Hospital or the Sanatorio Güemes Private Hospital in Buenos Aires, Argentina between June 2009 and May 2010.Results: Ninety‐nine patients were recruited. Forty‐four had a diagnosis of COPD, and 55 patients had cancer. Seventeen of the patients expected their health to improve in the future, but a significantly higher proportion of patients with malignant disorders expected to get better in the near future as compared with those with COPD (98.2% vs 62.8%, P < 0.001). Most study participants expressed a desire to receive all the information available about their condition. A majority of the participants expressed a preference for making treatment decisions in collaboration with their physician (40.4%)Conclusions: While they considered the role of their families relevant and wanted information to be shared so that family members might participate in decision‐making, they did not want their families to have a right to withhold information, make final decisions.

Endobronchial ultrasound (EBUS), using the radial EBUS probe and convex-probe EBUS-guided transbronchial needle aspiration, are increasingly advocated for a wide array of minimally invasive thoracic procedures. The effectiveness of EBUS-guided procedures has been demonstrated to a degree that, in many institutions, EBUS is becoming standard of practice for the diagnosis, staging and restaging of mediastinal lymphadenopathy in lung cancer, the diagnosis of sarcoidosis, and for bronchoscopic biopsy of peripheral lung lesions. Its role in other bronchoscopic procedures requires further study despite an already strong body of literature: diagnosis of lymphoma and benign infectious disease, diagnosis of early lung cancer and airway wall disorders, imaging of thoracic vascular disease such as pulmonary embolism, and therapeutic procedures such as placement of fiducial markers. In this article, we illustrate some of the principles of EBUS, describe major technical aspects pertaining to the procedure itself and provide a narrative review of original research addressing proposed roles of EBUS in a variety of indications. In closing, we describe future perspectives including new educational processes and philosophies that could favorably impact the rapid and safe dissemination of this evolving technology into clinical practice.

This chapter discusses the issue of informed consent as seen in the film Extreme Measures (1996). The film tells the story of Dr. Guy Luthan (Hugh Grant), an emergency room physician, who faces issues of conscience and professionalism after one of his patients, a homeless man dies and his body disappears. As the young doctor begins inquiries into the incident, he meets world-renowned neurosurgeon Dr. Lawrence Myrick (Gene Hackman), who performs experimental spinal surgeries on the homeless, without their consent, in an attempt to cure paralyzing spinal disorders. The chapter argues that regardless of place or type of medical practice, respect for individual autonomy mandates the informed consent process. Informed consent helps ensure the satisfaction of legal and ethical obligations, and enhances the quality and safety of patient treatments and procedures.

Résumé Les fondements de l’Action Humanitaire, au-delà de la norme légale qui est essentielle puisqu’elle entraîne des obligations inaliénables pour tous les États qui y souscrivent, sont empreints par des concepts philosophiques et politiques ancrés dans une éthique de la justice. Le contractualisme Rawlsien postule que les actions humanitaires sont basées sur l’idée qu’aider est une option noble et désirable, mais qui reste une option et pas une obligation. Peter Singer et Thomas Pogge nuancent la compréhension du devoir d’assistance. Ne pas aider serait mal et intrinsèquement équivalent à tuer. Aider n’est pas un acte caritatif digne d’éloges mais une obligation morale. Les impératifs financiers des associations, la complexité croissante des activités et le développement d’un important volet de communication entraine une professionnalisation de la médicine humanitaire. Une vision moderne de l’action humanitaire repose sur une meilleure compréhension de la justice, la solidarité et l’action globale. Pour nous donc, s’impose un ferme rapprochement éthique de l’action humanitaire avec des implications politiques claires.