Bilateral Singapore fasciocutaneous flap after anterior vulvectomy and distal urethrectomy for localized recurrent vulvar carcinoma.

Introduction: Vulvar cancer has an overall low incidence, accounting for approximately 3-5% of all gynecological malignancies.Case: We present a case of locally recurrent Stage IIIA squamous cell carcinoma of the vulva in a 51-year-old healthy African American female. She was initially treated with primary chemoradiation with cisplatin sensitization and boost to primary tumor up to 70 Gray.

Racial disparity in excess mortality in Brazil during COVID-19 times.

We evaluated the impact of the COVID-19 pandemic on excess mortality by race/skin colour in Brazil, between epidemiological weeks 12 and 50 of 2020. We compared the 2020 point estimate and the expected point estimate applying 2019 mortality rates to the 2020 population. There was an excess of 187 002 deaths (+20.

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position.

Objective: Breast cancer radiotherapy is increasingly delivered supine with multiple, short breath-holds. There may be heart and lung sparing advantages for locoregional breast cancer of both prone treatment and in a single breath-hold. We test here whether single prolonged breath-holds are possible in the prone, front crawl position.

Understanding and Parenting Children's Noncompliant Behavior: The Efficacy of an Online Training Workshop for Resource Parents.

The current study examined the effectiveness of an online training program on parenting children's noncompliant behavior. Eighty-two resource parents (foster, adoptive, and kinship) were recruited through Foster Parent College-an online training website-and randomly assigned to a treatment or wait-list control group. Parents in the treatment group participated in an online interactive workshop on noncompliant child behavior.

Efficacy of Blended Preservice Training for Resource Parents.

To evaluate a new way of meeting the growing demand for training prospective resource parents, our study compared the efficacy of a blended online and in-person approach with a traditional classroom-only approach. Findings based on a sample of 111 resource parent prospects showed significantly greater gains in knowledge from pre- to posttest for the blended approach over the classroom-only approach. The blended approach also produced dramatically lower dropout rates during preservice training.

Web-Enhanced Preservice Training for Prospective Resource Parents: A Randomized Trial of Effectiveness and User Satisfaction.

Traditionally, prospective resource parents must attend all preservice training in person. While live sessions are necessary for activities such as screening applicants, instructional portions of training could be enhanced by web-based sessions. This pilot study compares the effectiveness of online and classroom versions of one session from a widely used preservice training program.

Effects of combination dobutamine and vasopressin therapy on microcirculatory blood flow in a porcine model of severe endotoxic shock.

Background: Dobutamine (DB) has been recommended in combination with vasopressor therapy in septic shock, given its reported ability to improve mesenteric and microcirculatory perfusion. Vasopressin (VP) is typically reserved as a second-line agent due to the concern of ischemia. The purpose of our study was to determine whether combination DB and VP therapy improved microcirculatory blood flow in severe endotoxic shock.

Experience with free TRAM breast reconstruction at an American Army Medical Center.

There are many civilian reports on the outcomes of the free transverse rectus abdominis muscle (TRAM) flap for breast reconstruction. There are no published reports by U.S.

Operation Iraqi freedom: A report on a series of soldiers treated with free tissue transfer by a plastic surgery service.

Free flaps in combat wounds are predisposed to failure. Few reports are available on their use in American military combat wounds. We present our experience with free flaps during Operation Iraqi Freedom.

Neuropsychological screening for cognitive impairment using computer-assisted tasks.

The aim of this study was to validate a computer-assisted screening battery for classifying patients into two groups, those with and without cognitive impairment. Participants were all patients referred to the neuropsychology clinics at four VA medical centers during a 1-year period. Patients meeting the study inclusionary criteria (N = 252) were administered the Neurobehavioral Evaluation System-3 (NES3) computer-assisted battery.

Interrater reliability of neuropsychological diagnoses: a Department of Veterans Affairs cooperative study.

This study examined the interrater reliability of neuropsychological diagnoses produced by clinical neuropsychologists across 4 medical centers. These diagnoses were based on evaluations using a comprehensive battery of commonly used neuropsychological test instruments, interview, history and medical chart review. The diagnoses of individual neuropsychologists were compared to those made by members of an external review panel for each patient evaluated.

Mortality associated with the quality of care of patients hospitalized with congestive heart failure.

Objective: This study examined the association between use of angiotensin converting enzyme inhibitors (ACEIs) and risk of death in elderly patients hospitalized with left ventricular systolic dysfunction (LVSD).

Design: Retrospective cohort study.

Setting: Despite evidence showing the benefit of treating LVSD with ACEI, elderly patients with LVSD are often not treated with an ACEI.