Intimate Examinations Research Articles

The Financial Considerations of Employing a Dedicated Chaperone in Clinical Practice.

Introduction: Medical associations and medicolegal bodies are urging for increased chaperone use by physicians during intimate physical examinations in clinical practice (such as breast or pelvic examinations). However, widespread chaperone use is limited by factors such as staff availability and financial considerations. Presently, there is a scarcity of information available regarding the cost of hiring a dedicated chaperone. This study investigates the cost of hiring a chaperone and its financial implications for a physician's clinical practice. Materials and Methods: Using data from the Government of Canada website, the range of salary rates for clinic staff who can act as a chaperone in Canada was analyzed. The cost of hiring a chaperone was estimated to be in the range between the cost of hiring a minimum-wage worker and a nurse (the highest-paid hired medical office staff). Obstetrics and Gynecology as well as Plastic Surgery urban community practices were consulted regarding the costs of operating a clinic. Results: The approximate annual income for a minimum-wage worker in Canada is $29,250 CAD. Registered nurses earn on average $72,783.75 CAD per year. The cost of operating a private clinic practice with one staff member in Canada is on average $102,500 CAD per year. Thus, hiring an additional full-time chaperone could increase clinic expenses by approximately 49% per year, bringing the clinic cost to approximately $153,517 CAD per year. For part-time employment, the annual cost of hiring a chaperone is approximately $10,203 CAD for each day/week of employment. Conclusion: In terms of financial considerations, hiring a chaperone can increase clinic expenses by approximately one-and-a-half times. The findings of this study provide an important reference for physicians and may assist with the decision to employ chaperones in clinical practice.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

‘A good goal can’t be told’: Narration and memory in the soccer stories of Pablo Santiago Chiquero

A common obstacle to effective sports writing is the challenge of capturing the excitement of the live moment as it unfolds on pitch, field, or court. The burst of emotion of the mass sports spectacle is easily lost when an author attempts to translate the experience to textual narration. In his 2016 short story collection, Once goles y la vida mientras (Eleven Goals and Life Goes On), the Spanish journalist and author Pablo Santiago Chiquero approaches this tricky literary terrain through an intimate examination of the personal power of soccer in everyday lives. By focusing on one particular historical football goal in each of his stories, Santiago Chiquero subtly examines the multiple facets of personal, collective, and counter-factual memory. The goals, dating from 1983 to 2013, serve as pretext for exploring why sport has been both criticised and celebrated as an “escape valve” for contemporary society. Santiago Chiquero’s stories demonstrate how a public event, such as a soccer goal, transcends the time and place of its occurrence and is recreated in personal memories in ways that both alleviate and enhance individual joy and suffering.

A “Rule of Four” Approach to the Male Genital-Rectal Examination

A detailed yet simple genital-rectal examination format with helpful notations is given to ensure an efficient and thorough examination with attention to both clinician and patient sensitivities regarding an intimate examination of the genital and rectal areas of the body. Techniques and tips for successful implementation of this examination are provided.

Effectiveness of Communication Skills Training in Medical Students Using Simulated Patients or Volunteer Outpatients.

Communication skills are the vital basis for patient-doctor interactions in undergraduate medical education. With excellent patient-physician interaction and communication, patients will likely build better rapport and trust with the physician. This allows all the necessary information to be divulged with the reassurance of confidentiality and devise appropriate investigations and treatment plans that patients would be more inclined to follow. The most common and effective ways of teaching communication skills to medical students are by using simulated patients and volunteer outpatients. However, which types of patients to use for better development of practical communication skills training. Establishing the demonstrable difference between using two kinds of patients would refine the training scheme for students. This would produce doctors that have practical communication skills and enhance their care to assist patients on their road to recovery or palliative care. This review compares and establishes the effectiveness of medical students’ communication skills training using simulated patients and volunteer outpatients about the adult learning theories.This research is carried out following a critical review of internationally reputed guidelines from the World Health Organisation (WHO) and the General Medical Council (GMC). Several search terms were used on various online databases such as Medline (Ovid), PubMed, and Academic Medicine. A thorough selection process was applied using the inclusion and exclusion criteria to narrow the search. Four studies related to this review’s aim were collected and critically analyzed. The methods of obtaining the studies were structured using the PRISMA guidelines. The studies showed that one study favored volunteer outpatients while the other preferred having simulated patients. Another study showed that students considered both types of patients essential for communication skills training.All the studies presented the strengths and weaknesses of both simulated and volunteer outpatients. Discussion of the validity of all analyses was based on the CASP criteria. Study design, sample selection, and biases were scrutinized for each study. Various adult learning theories were used to correlate the effects of the communication skills training. In conclusion, simulated patients are more useful for pre-clinical years, intimate examination, and giving instructions about the physical examination. Whereas volunteer outpatients are put to better use in clinical years to incorporate more medical aspects such as obtaining a differential diagnosis, management of illness, and procedural techniques. Introducing different types of patients based on their study progression and topic of discussion could be adapted.

Then Comes the Evening

Set amid the remote hills of Eastern Bosnia, THEN COMES THE EVENING provides a quiet meditation on the seemingly uncomplicated pastoral lives of two women. Through simple and precise composition with attention to light and texture, the mundane details of their lives are rendered with the tactile richness of an oil painting. Their every action and word is infused with ceremony, ritual, and intangible cultural heritage in this intimate yet epic examination of how nature and humanity interact.

Women's Birthing Bodies and the Law: Unauthorised Intimate Examinations, Power and Vulnerability, edited by Camilla Pickles and John Herring.

Women's Birthing Bodies and the Law: Unauthorised Intimate Examinations, Power and Vulnerability, edited by Camilla Pickles and John Herring.

The Yellow Flag: Quarantine and the British Mediterranean World, 1780-1860, by Alex Chase-Levenson

Reviewed by: The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860 by Alex Chase-Levenson Kathleen Frederickson (bio) The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860, by Alex Chase-Levenson; pp. xi + 307. Cambridge: Cambridge University Press, 2020, £75.00, $99.99. Alex Chase-Levenson's The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860 offers an engaging examination of a period when maritime quarantine was at its height. In the early- and mid-nineteenth century, worries about importing plague, yellow fever, and cholera intensified in Western Europe as European countries imported more and more materials from the Middle East and North Africa, and as Europeans traveled across the Mediterranean with growing frequency. Chase-Levenson offers a compelling and robust account of the quarantine system that was designed to respond to this panic. To begin, the archival research evident in the book is impressive. In addition to published sources, Chase-Levenson reads English, French, and Italian manuscripts from boards of health, lazaretto staff, and consuls at Marseille, Malta, Naples, Livorno, and Genoa—the locations of major Mediterranean quarantine stations operating in the early nineteenth century. In addition, the book does well to examine the land lazarettos on the border between the Ottoman and Habsburg empires, quarantine locations that are often left to the side in other histories. Though even more attention to the economic considerations shaping quarantine politics would render the book still stronger, the book provides a thick, interesting, and nuanced account of the myriad ways in which quarantine structured the geopolitics of this era. Throughout the course of the book, Chase-Levenson seeks to understand how quarantine operated on a number of geographic scales. In the cities and towns adjoining lazarettos, quarantine shaped local economics, health, and culture. Nationally, legislators coordinated military and economic aspirations with the advice of the local health boards governing lazarettos. Lastly, European quarantine officials gradually established common standards, slapping any nation that departed from these norms with retaliatory quarantines, such that individual nations were chary of relaxing their own rules. The result of this cooperation across borders was to turn much of Europe into a single bio-polity even at a moment when, Chase-Levenson argues, "international law barely existed" (48). The book therefore toggles its view between big picture explanations of Europe's relationship with the flagging Ottoman Empire and more fine-grained interpretations of an individual lazaretto or port city. The first two chapters of The Yellow Flag make use of the more wide-ranging of these lenses as Chase-Levenson seeks to explain how quarantine responded to Britain's activities in the Mediterranean world. Among the strengths of Chase-Levenson's account is its focus on military quarantine, a topic that too often escapes attention in histories of quarantine. War and conquest presented logistical hurdles to quarantine processes. After Napoleon's ill-fated Egyptian campaign, the Marseille lazaretto had to quarantine 30,000 [End Page 115] returning French soldiers over the course of a year—no small feat for a lazaretto that usually received only 300 to 1,000 people annually. In the context of the Napoleonic Wars, it was especially notable that quarantine officials developed what was de facto transnational regulation, such that warring countries found themselves allied with and dependent on their enemies in the domain of health. This transnational regulation continued after 1815, when Britain had to accommodate itself to the protocols established by Continental powers, even though it occupied an increasing position of military might and imperial trade power in the Mediterranean. The second cluster of chapters adopts a more intimate examination of the world of the lazaretto, from the procedures of lazaretto life to the relationships between national governments and the health boards in charge of quarantine practices. While the period Chase-Levenson studies saw the standardization of a number of quarantine practices around duration and disinfection, it also developed lazarettos that offered radically different experiences of quarantine life. The larger Mediterranean lazarettos offered restaurants of varying quality, a range of accommodations, and parlatorios through which those in quarantine could speak to merchants and friends on the outside—this last a convenience made possible by the fact that...

Pregnancy and childbirth during incarceration: A qualitative systematic review of lived experiences.

Incarcerated individuals who experience pregnancy or childbirth in correctional facilities face unique considerations for obstetric care and consequently are at greater risk of adverse maternal and fetal outcomes. To characterise patient experiences regarding pregnancy and childbirth during incarceration via qualitative synthesis. Medline-OVID, EMBASE, CINAHL, Sociological Abstracts, Social Work Abstracts, Web of Science, Scopus and PsycInfo were systematically searched from inception to 24 December 2020. Supplementary searches were performed using the Scopus database. Only original, peer-reviewed literature was examined. Eligible studies were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. After screening 4173 original database citations, 24 studies that met inclusion criteria were included and analysed via thematic analysis. The 24 studies included perspectives from 645 female patients who had experienced incarceration, 69 healthcare providers and 70 prison staff. Key patient-reported concerns for the well-being of pregnant individuals during incarceration included mental health challenges, dehumanisation of prenatal care and delivery, lack of privacy, stigma, psychological trauma, lack of emotional support and shackle usage during pregnancy and/or labour. The studies reported a lack of support for patients to access female correctional officers or guards, privacy during intimate examinations, timely medical care and support for breastfeeding. Above all, the psychological trauma of separation from one's newborn after birth was of utmost devastation. Our systematic review highlights the dire need for accountability and interventions to improve pregnancy and childbirth care for incarcerated individuals. This systematic review describes lived experiences of pregnancy & childbirth during incarceration, including dehumanisation, psychological trauma, and use of shackles.

‘Wellbeing’ examinations in child sexual assault outside of children’s hospitals

Large-scale studies on child sexual assault (CSA) has shown the majority of children and young people disclose their abuse over a month to more than a year later.1 Delay in disclosure can be influenced by many factors. There has been historical views that a paediatric assessment, after a delay disclosure, has a low yield for finding forensic evidence and that an ‘intimate examination’ may ‘repeat the abuse’. The perception may have led to clinicians feeling there are few benefits in seeing children for an assessment when out of ‘forensic’ time frame.

Consent for Intimate Exams on Unconscious Patients: Sharpening Legislative Efforts.

The practice of nonconsensual intimate exams performed on unconscious patients by medical students during their training has received significant attention in the last several years. Clinicians, medical students, bioethicists, lawyers, and the public have called for explicit and specific consent to take place before all educational intimate examinations of unconscious patients. In response, since January of 2019, dozens of bills have been proposed in more than twenty states, and thirteen of these have been signed into law (in addition to six that passed before 2019). Here, we consider the content of these enacted bills, drawing attention to five variable features and offering these five corresponding legislative recommendations, in hopes of narrowing in on the appropriate ethical scope of consent laws surrounding educational intimate exams: (1) use gender-neutral language; (2) include all intimate exams, not solely pelvic exams; (3) focus on unconscious patients; (4) focus on educational exams; and (5) regulate systems, not individuals.

Management of urinary incontinence in athletic women: the POsITIve feasibility study

ObjectivesTo investigate the feasibility and acceptability of conducting a future trial of physiotherapy to manage urinary incontinence (UI) in athletic women. DesignFeasibility study with nested qualitative interviews. SettingCommunity clinics: university and private. ParticipantsAdult women who i) lived locally, ii) provided informed consent iii) self-reported UI iv) exercised at high/moderate intensity for over 150 minutes and over three times a week. InterventionsUp to seven sessions of tailored physiotherapy delivered over 6-months. Despite some variation in prescription and progression, all programmes included elements of pelvic floor muscle training undertaken in clinic and at home. Main outcome measuresRecruitment, eligibility of those screened, consent, data completion and attendance rates: assessed to determine feasibility of progression to a definitive trial. The acceptability of specific outcome measures, the intervention and of randomisation within a future trial was also examined. ResultsDirect recruitment of athletic women from sporting venues was feasible and acceptable. Most women not only consented to an intimate examination as part of the assessment, but described this as an important part of the intervention. Attendance rates and data completion was generally high but the return of 3-day fluid charts was poor: this was also reflected in comments by participants that these were difficult to incorporate into daily life. The addition of a smartphone app to aid motivation and monitoring was welcomed but further education in its use may enhance compliance. ConclusionsDirect recruitment from sporting venues was acceptable and feasible. Women valued assessment and treatment for UI. Clinical Trial Registration NumberNCT03986411.

Medical students' experiences in learning to perform pelvic examinations: a mixed-methods study.

ObjectivesWe aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training. MethodsA mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ2 test or Fisher's exact test. Results160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities. ConclusionsThe importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.

A case of ectopic pancreas of the stomach accompanied by intraductal papillary mucinous neoplasm with GNAS mutation

BackgroundEctopic pancreas is basically a benign disease and is not always necessary to be removed. However, all types of neoplasms occurring in the normal pancreas such as ductal adenocarcinomas and intraductal papillary mucinous neoplasms (IPMNs) may develop even within ectopic pancreas. We recently encountered an extremely rare case of ectopic pancreas in the gastric antrum associated with IPMN possessing a GNAS mutation.Case presentationA 71-year-old Japanese woman complained of epigastric pain. Computed tomography and upper gastrointestinal endoscopy showed an intramural cystic mass in the antrum of the stomach. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy did not give a definitive diagnosis, and the patient underwent resection of the lesion. Histology of the resected specimen showed that the gastric intramural lesion was ectopic pancreas. Moreover, the lesion contained dilated duct components with tubulo-villous epithelial proliferation consistent with pancreatic IPMN. Since the covering epithelial cells had highly atypical nuclei, the lesion was diagnosed as IPMN with high grade dysplasia. Immunohistochemistry showed that the IPMN component showed to be MUC2-, MUC5AC-, and CDX2-positive but MUC1- and MUC6-negative. Mutational analyses using genomic DNA revealed that the IPMN component had a mutation of GNAS at exon 8 (Arg201Cys).ConclusionWe finally diagnosed this case as gastric ectopic pancreas accompanied by intestinal type IPMN with high grade dysplasia possessing GNAS mutation. Although there were 17 cases of ectopic pancreas with IPMN including 6 cases of gastric ones reported in the English literature, this is the first case of ectopic pancreas with IPMN which was proved to have GNAS mutation. Intimate preoperative examinations including imaging analyses and EUS-FNA biopsy/cytology are recommended to decide whether the lesion has to be resected or not even if they are not effective for getting the right diagnosis.

Fame is the Name of the Game

In her wide-ranging and richly illustrated book, Sharon Marcus offers an intimate examination of the life and career of the Parisian actress Sarah Bernhardt (1844–1923) in order to demonstrate the way celebrity is achieved and performed. An internationally celebrated performer, Bernhardt emerged from the Théatre Française (aka Comédie Française) to mould her own career through a canny series of moves that Marcus interrogates in detail. The result is an intriguing enquiry into the changing nature of celebrity itself and the way its embodiments shape a reputation. Marcus begins with a penetrating assessment of the historical meaning of celebrity. She notes its domination by men (often royalty, politicians, or warriors). Fame was generally outside the power of those elevated. Thus, monarchs had their heads on currency due to custom, not due to their actual popularity. But Marcus wants to unpack how this shifted in the nineteenth century and became increasingly...

1405 Improving Documentation of Per Rectal (PR) Exams in An Acute Surgical Unit

Abstract Aim A PR exam is routinely performed as part of the complete examination of surgical patients. The General Medical Council (GMC) has provided guidance on the use of chaperone during intimate exams stating that consent should be obtained, and a chaperone offered to all patients and documented accordingly. We aimed to assess and improve our documentation of PR exams. Method Data was collected prospectively from surgical admission documentation. The number of patients with consent and presence of chaperone documented during PR exam was recorded. Following a period of data collection, a proforma was implemented with education on correct documentation as per guidelines. A second audit cycle was performed where formal inclusion of the sticker in the admission booklet was implemented. Results 20 patients were included in the initial data collection, 95% of which had incomplete documentation of PR exam on admission. A sticker was designed to prompt accurate documentation and inserted into the acute admissions booklet. Following this, 50% of PR exams were correctly documented. The remaining 50% without documentation had no sticker in the admission booklet. The second intervention included changing the hardcopy of the admission booklet. Following this, 80% of patients had consent documented and 90% had documented chaperone. Conclusions GMC guidelines state that documentation of consent and the presence of chaperones during intimate medical examinations are crucial. The implementation of a prompt in our admissions booklet has greatly improved our documentation in PR examination.

Camilla Pickles and Jonathan Herring (eds.): Women’s Birthing Bodies and the Law. Unauthorised Intimate Examinations, Power and Vulnerability

Camilla Pickles and Jonathan Herring (eds.): Women’s Birthing Bodies and the Law. Unauthorised Intimate Examinations, Power and Vulnerability

Terra pericolosa: medical student involvement in intimate patient examinations or procedures.

Terra pericolosa: medical student involvement in intimate patient examinations or procedures.

Camilla Pickles and Jonathan Herring (eds), Women’s Birthing Bodies: Unauthorised Intimate Examinations, Power and Vulnerability

Camilla Pickles and Jonathan Herring (eds), Women’s Birthing Bodies: Unauthorised Intimate Examinations, Power and Vulnerability

Caring for affective subjects produced in intimate healthcare examinations.

This article is about the feelings - affect - induced by the digital rectal exam of the prostate and the gynaecological bimanual pelvic exam, and the care doctors are or are not instructed to give. The exams are both invasive, intimate exams located at a part of the body often charged with norms and emotions related to gender and sexuality. By using the concept affective subject, we analyse how these examinations are taught to medical students, bringing attention to how bodies and affect are cared for as patients are observed and touched. Our findings show both the role care practices play in generating and handling affect in the students' learning and the importance of the affect that the exam is (or is not) imagined to produce in the patient. Ours is a material-discursive analysis that includes the material affordances of the patient and doctor bodies in the affective work spaces observed.