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Abstract: Objective: To evaluate the caregivers’ opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly. Material and methods: Questionnaire survey using a semi-structured survey based on visual analogue scales, sent to all multidisciplinary centres for prenatal diagnosis in France. Answers were received from 26 centres nation-wide. Results: Response rate was 39% (213 responses received over 550 questionnaires sent). Fifty-five percent of respondents were women, 90% physicians, 7,5% midwives. A vast majority (69.8%) believes that their own convictions play a bigger role in decision in real practice than in their ideal. The major decisional factors in decision-making for TOP are: the long-term prognosis of the anomaly, a specialized opinion on its curability, the quality of the information given to the future parents, their expressed opinion, the existence of a multidisciplinary decision, the ability of the future parents to understand the medical data, the obtention of a medical consensus, the proof level of the medical information. For only 55% of the respondents, the current legal framework is adequate to manage the situations that result from prenatal diagnostic practices today. The question of late third-trimester TOP raises ethical debate: over a third (37%) see no ethical difference between TOP and withdrawal of care during the neonatal period; the majority (48% versus 43%) feel that ethically speaking a neonate and a foetus at 39weeks gestational age (GA) should not be treated differently; 37% of the respondents feel that current practice is likely to lead to eugenism. Discussion and conclusion: As far as TOP is concerned, the huge discrepancies in responses from the professionals highlight the ongoing ethical debate, especially concerning the concept of informed choice in TOP, which we believe should be entirely revisited. [Copyright &y& Elsevier]

Physicians frequently face ethical dilemmas when caring for patients. To help them to cope with these, biomedical ethics aims to implement moral norms for particular problems and contexts. As a means of studying the cognitive and neurobiological features underlying the respect for these norms, moral cognitive neuroscience could help us to understand and improve ethical questioning. The article reviews recent developments in the field and presents neurobiological arguments to highlight why some moral rules are universally shared and why some ethical responses are very dependent on context. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article by A.L. Glenn, A. Raine, and R.A. Schug, on increased activity of dorsolateral prefrontal cortex (DLPFC) during moral decision-making.

A letter to the editor is presented in response to the article "The impact of two-dimensional versus three-dimensional ultrasound exposure on maternal-fetal attachment and maternal health behavior in pregnancy," by B. Sedgmen, C. McMahon, D. Cairns, B. J. Benzie and R. L. Woodfield.

Abstract: Introduction: In the elderly, both the presence of a multiple pathology and multiple medication have been shown to be frequent risk factors for adverse drug events. However, a few studies only have included parameters of standardized geriatric assessment for the purpose of identifying other risk factors. Our study compared the parameters of standard geriatric assessment, in the presence or absence of adverse drug events and evaluated the prevalence of adverse drug events in elderly inpatients, the symptoms, and the drugs involved. Methods: A total of 823 patients were studied during a two-year period. Two groups of patients were identified, according to the presence or absence of an adverse drug event. Eight fields of geriatric assessment were compared: comorbidities, number of drugs, functional status, nutritional status, mobility, mood, neurosensory disorders, and cognition. For patients who experienced an adverse drug event, we also analyzed the drugs involved and the symptoms of the adverse drug events. Results: One hundred and twelve patients (13.6%) aged 82 years±7.5 experienced 144 adverse drug events. Significant differences between the two groups were observed in the following: symptoms of depression, problems of mobility, risk of malnutrition (respectively p =0.001, p =0.002, p =0.007), the female sex, number of drugs, number of comorbidities, and the administration of diuretics. Cardiovascular (23.2%), psychotropic (17.9%) and anti-infectious (17%) medicines were the most frequently involved. The symptoms that occurred most frequently were orthostatic hypotension (14.6%), gastrointestinal disorders (12.5%), and neuropsychological (10.4%) disorders. Conclusion: Elderly patients with multiple pathology and multiple medication are at high risk for adverse drug events. Other lesser known factors, such as depression, problems of mobility, and malnutrition must be researched, as they are evidence of the underlying the frailty of the elderly population. [Copyright &y& Elsevier]

La colonisation bactérienne chronique du grêle (CBCG), diagnostiquée par un test respiratoire au glucose, est une complication fréquente de la chirurgie bariatrique. Les symptômes de la CBCG sont aspécifiques à type de douleurs abdominales, de ballonnement et de diarrhée. Les traitements de décontamination digestive par antibiothérapies orales séquentielles sont variés et non codifiés. Le but de cette étude rétrospective était d'analyser les caractéristiques d'une cohorte de patients opérés d'une chirurgie bariatrique ayant réalisé un test respiratoire au glucose pour une symptomatologie évocatrice de CBCG et d'analyser l'efficacité des antibiothérapies de décontamination digestive utilisées. Entre janvier 2018 et avril 2019, 101 patients opérés d'une chirurgie bariatrique (by-pass en Roux-en-Y, en oméga et sleeve-gastrectomie) ayant réalisé un test respiratoire au glucose au Centre Hospitalier Universitaire de Dijon (50 g per os, test positif défini par une [H2] basale > 20 ppm ou une élévation par rapport à la basale > 10 ppm dans les 2 premières heures), ont été inclus. Les données anthropométriques, les symptômes, le type de chirurgie bariatrique, la prise d'inhibiteurs de pompe à proton (IPP), l'antibiothérapie et sa durée ont été recueillies de manière rétrospective. L'efficacité du traitement antibiotique, définie par une amélioration des symptômes constatée par le patient était évaluée lors des consultations de suivi ou par téléphone. Des tests de Chi2 ont été réalisés pour les analyses statistiques avec p < 0,01 (correction de Bonferroni). Sur les 101 patients inclus (85 femmes, 16 hommes, âge 48,5 ± 3,6 ans), 63 avaient bénéficié d'un by-pass en Roux-en-Y, 31 d'un by-pass en oméga et 7 d'une sleeve. 76 patients présentaient une diarrhée, 52 une douleur abdominale et 20 des ballonnements. Le test respiratoire au glucose était positif chez 84 patients. Un test positif était associé significativement à la prise d'IPP (p < 0,01), à l'âge (p < 0,001) et au genre féminin (p < 0,01), mais il n'y avait pas de différence significative selon le type de chirurgie. Vingt patients sur les 33 traités par une antibiothérapie séquentielle de type gentamycine/métronidazole, décrivaient une efficacité du traitement. Sur les 40 patients traités par métronidazole seul, 23 décrivaient une efficacité. Les 11 patients restants suivaient une antibiothérapie autre (quinolone et rifaximine) ou une absence de traitement. Il n'y avait pas de différence d'efficacité significative entre les différents traitements (p = 0,87). La CBCG doit être systématiquement recherchée en cas de symptomatologie évocatrice chez des patients aux antécédents de chirurgie bariatrique, quel que soit le type de chirurgie, mais plus particulièrement chez les patients les plus âgés, de genre féminin et en cas de traitement par IPP. L'efficacité semblait similaire entre les 2 antibiothérapies séquentielles orales de décontamination digestive les plus fréquemment prescrites dans notre cohorte (gentamycine/métronidazole et métronidazole). [ABSTRACT FROM AUTHOR]