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Introduction: Emergency Medicine Physicians have been incorporating Point-of-Care Ultrasound (POCUS) into their practice for over twenty years. Only recently has its use become more widespread in the practice of Pediatric Emergency Medicine (PEM). Recent guidelines have described the scope of applications for PEM physicians. However, no consensus exists as to which applications should be prioritized and routinely taught to PEM fellowship trainees and therefore expected of PEM graduates as they enter practice. The PEM POCUS Network, a multinational group of Physicians with POCUS expertise formed in 2014, set out to reach expert consensus as to which applications should be incorporated into PEM fellowship training curricula. Methods: A multinational group of PEM POCUS experts was recruited from the PEM POCUS Network via a screening process that identified PEM physicians who have performed over 1000 pediatric POCUS scans and met any of one of the following criteria: having 3 years or more experience teaching POCUS to PEM fellows, being local academic POCUS leaders or had completed a dedicated PEM POCUS fellowship. These experts rated each of the 60 possible PEM POCUS applications using a modified Delphi consensus building technique for their importance in inclusion into a PEM Fellowship curriculum. Consensus was reached when >80% of respondents agreed to include or exclude each item. Results: In the first round, 66 out of 92 (72%) PEM POCUS Network members responded to the survey email, of whom 45 met expert criteria and completed the first round. During round 1, consensus was reached to include 18 of the 60 applications in a PEM fellowship curriculum and to exclude 2 applications from a PEM fellowship curriculum. Eighty-two percent (37 /45) of the experts completed Round 2 where 40 items were rated; consensus was reached to include 3 additional applications and exclude 5 applications. The decision was made not to carry on with future rounds after this stage, since no significant changes were observed between the two rounds, with regard to items that had not reached consensus. Conclusion: This project of the PEM POCUS Network reached consensus on 21 applications that should be included in a PEM Fellowship curriculum. This project will have significant impact on how PEM fellowships teach POCUS to their trainees.
Written with the busy practice in mind, this book delivers clinically focused, evidence-based gynecology guidance in a quick-reference format. It explores etiology, screening, tests, diagnosis, and treatment for a full range of gynecologic health issues. The coverage includes the full range of gynecologic malignancies, reproductive endocrinology and infertility, infectious diseases, urogynecologic problems, gynecologic concerns in children and adolescents, and surgical interventions including minimally invasive surgical procedures. Information is easy to find and absorb owing to the extensive use of full-color diagrams, algorithms, and illustrations. The new edition has been expanded to include aspects of gynecology important in international and resource-poor settings.
Vulvectomy is performed for both preinvasive and malignant conditions of the vulva. This procedure may vary in extent from a skinning procedure performed for multi-centric intraepithelial neoplasia to a radical vulvectomy combined with bilateral inguinofemoral lymph node dissections for invasive carcinoma. The radical procedure has changed during the past decade; it may range from a hemivulvectomy with unilateral inguinofemoral lymph node dissection to a radical vulvectomy with bilateral inguinofemoral lymph nodes dissection. A three-incision method for radical vulvectomy with bilateral lymph node dissection is preferred over en bloc removal because the multiple incision method has a significantly decreased rate of wound breakdown.
Lateralizing stage T1 lesions that are smaller than 2 cm are treated with a radical hemivulvectomy and ipsilateral lymph node dissection. For larger or midline lesions, attempts are made to perform a radical vulvectomy and bilateral inguinofemoral lymph node dissections through separate incisions (three-incision technique). This approach generally results in fewer postoperative complications (e.g., wound infections) and a shorter hospital stay. The time necessary for this operation is 2–5 hours, and varies according to the extent of resection and reconstruction. Depending on the extent of resection, gracilis or rectus abdominis myocutaneous flaps, Z-plasty full-thickness pedicle flaps, or V–Y advancement flaps may be needed to fill the operative defect. Large defects in the vulva can be reconstructed with split-thickness skin grafts. Closed suction drains are often placed in the operative site to reduce the formation of lymphocysts and to improve wound healing. General, regional, or combination anesthesia can be equally efficacious. Intraoperative transfusions are not routinely required during a radical vulvectomy.
We describe the La Silla-QUEST (LSQ) Variability Survey. LSQ is a dedicated wide-field synoptic survey in the Southern Hemisphere, focussing on the discovery and study of transients ranging from low redshift (z < 0.1) SN Ia, Tidal Disruption events, RR Lyræ variables, CVs, Quasars, TNOs and others. The survey utilizes the 1.0-m Schmidt Telescope of the European Southern Observatory at La Silla, Chile, with the large-area QUEST camera, a mosaic of 112 CCDs with field of view of 9.6 square degrees. The LSQ Survey was commissioned in 2009, and is now regularly covering ~1000 square deg per night with a repeat cadence of hours to days. The data are currently processed on a daily basis. We present here a first look at the photometric capabilities of LSQ and we discuss some of the most interesting recent transient detections.