The new pan-European post-specialty training curriculum in Paediatric and Adolescent Gynaecology.

Interest in the field of Paediatric and Adolescent Gynaecology (PAG) has increased substantially over the last decade. Currently there is minimal consensus on how to interpret and validate professional experience, medical knowledge and surgical skills for doctors (accredited in Obstetrics and Gynaecology) who have an interest in and wish to achieve sub-specialisation in PAG. The challenge for the future of PAG is to create a framework of guidelines and references which in turn culminates in improvement and harmonisation in PAG healthcare delivery. The development of a post-specialty training curriculum in PAG for accredited practitioners was a logical next step after EBCOG introduced the PACT curriculum for OBGYN trainees. The guiding principle in the development of the PAG curriculum has been to strive for harmonisation in teaching and training in PAG within Europe. The new EURAPAG curriculum is divided in 17 chapters which in turn have been subdivided into medical and surgical sections plus a baseline skills section. The content has been determined through a consensus procedure amongst European gynaecologists and trainees. The medical chapters involve pathology that requires conservative treatment, prevention, education or lifestyle adjustment. The chapters that are both medical and surgical have a surgical (alternative) treatment ranging from vaginal procedures to advanced hysteroscopic and laparoscopic procedures and laparotomy. Currently, the framework for any medical education is workplace based competency training. Specific tools have been developed for workplace based assessments, such as direct observation (DO) of clinical task performance, Objective Structured Assessment of Technical Skills (OSATS), mini-clinical evaluation exercise (Mini-CEX) or case-based discussion (CBD). To measure progress in this PAG post-specialty training curriculum, the subspecialty trainee will be required to maintain and update a portfolio of experience and competency.

Successful Treatment of Severe Hyperammonaemia with Ultra-High Dose Continuous Veno-Venous Haemodiafiltration.

Hyperammonaemia is a severe condition and often requires a multimodal treatment regimen. Dialysis has been described as a potential treatment option, but currently it is not the standard of care. In this report, we describe a case of a 40-year-old postpartum woman who developed severe hyperammonaemia due to liver failure and acute kidney injury (AKI) combined with a large intra-abdominal haematoma producing nitrogen waste products. She was treated successfully with continuous veno-venous haemodiafiltration using an ultra-high effluent rate (100 mL/kg/h) and was discharged alive 32 days after the initial admission. Our report indicates that successful ammonia clearance in the setting of AKI can be obtained only by using this high effluent rate. This treatment modality should be considered in all patients with AKI and severe hyperammonaemia when other treatment modalities fail to lower ammonia levels within hours to prevent irreversible but preventable neurological damage.

Uterine preservation in pelvic organ prolapse using robot assisted laparoscopic sacrohysteropexy: quality of life and technique.

OBJECTIVE: Measuring quality of life of women with disorders of the pelvic floor is crucial when evaluating a therapy. The aim of this study is to profile health related quality of life of women with pelvic organ prolapse who are treated with robot assisted laparoscopic sacrohysteropexy (RALS). We also compare the operative characteristics and learning curve in this study with the current literature and describe the surgical technique. STUDY DESIGN: A prospective cohort study in a teaching hospital in The Netherlands. Fifty women with uterovaginal prolapse were treated with RALS. This study presents the largest cohort in Europe treated by RALS to date. Quality of life was assessed pre- and post-operatively using the UDI/IIQ validated self-questionnaire designed for Dutch-speaking patients. Clinical and operative data were prospectively collected up to 29 months. RALS was performed with preservation of the uterus. Statistical analysis of categorical data was performed with the paired T-test. Descriptive statistics were computed with the use of standard methods for means, median and proportions. RESULTS: Before operation, overall wellbeing was scored at 67.7% and after surgery this improved to 82.1% (p=0.03). Feelings of nervousness, frustration and embarrassment reduced significantly. Sexual functioning improved, but not significantly. The mean operative time was 223 (103-340) min. Operative time decreased significantly with gained experience and became comparable to the operative time for abdominal sacrocolpopexy and classic laparoscopy. Average blood loss was less than 50 ml and patients had a mean hospital stay of 2 days. Of all women, 95.2% were very satisfied with the result after RALS. CONCLUSION: Health related quality of life improves significantly after RALS. There are high rates of patient satisfaction. RALS proves to be a safe and effective treatment of pelvic organ prolapse. Operative time is comparable to abdominal sacrocolpopexy and classic laparoscopy in the current literature.