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This document provides guidance for helping students with questions about accessing electronic resources. It outlines four main steps: 1) Find out what resource the student wants and note details like title and author; 2) Determine how the student is trying to access it and if they are on or off campus; 3) Try accessing the resource yourself; 4) Use library search tools to check if the resource is available and troubleshoot issues like broken links, reporting problems to the appropriate team. The goal is to help students directly when possible and determine when to pass them to other specialists.Menieres slides-050518
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The document discusses various treatment controversies for Meniere's disease. It outlines the history and definition of the disease, as well as current understandings of physiology and pathophysiology. It then summarizes different medical, mechanical, intratympanic, surgical, and ablative treatment options and discusses evidence from studies evaluating their efficacy and side effects, finding that many options remain unproven or controversial while intratympanic gentamicin titration and vestibular nerve section/labyrinthectomy can reliably reduce vertigo.Mobility 2012 A multi-screen organization
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Shay Rosen discusses the need for organizations to become "multi screen organizations" to meet the demands of an increasingly mobile world. He notes that mobile has become a main access channel for enterprise services. A mature mobile channel requires having smartphone apps, tablet apps, and mobile websites to provide access to all services on all devices. A multi screen organization focuses on responsive web design with one site that adapts to different screen sizes and also uses a junction approach with a dedicated mobile website and options to download apps. Proper planning is needed to support continued exponential growth in mobile and ensure technology platforms can handle it with control, management, security and integration.N E W Y O R K C I T Ywilliam HOUGH
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The document discusses various types of vulvovaginal infections including bacterial vaginosis, candidiasis, trichomoniasis, atrophic vaginitis, and contact/irritant vaginitis. It covers the typical causes, symptoms, diagnostic approaches, and treatment options for each condition. Microscopic examination of vaginal discharge and pH testing are important diagnostic tools, while antibiotics and antifungal medications are commonly used for treatment.vesicular molle 2
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A vesicular mole, or hydatidiform mole, is a benign tumor resulting from abnormal fertilization. It has a higher incidence in Asia and in women over age 45. Complete moles have no fetal or placental tissue and are more likely to develop into gestational trophoblastic disease, while partial moles contain some fetal tissue. Ultrasound and serum markers can help differentiate between types of molar pregnancies. Surgical evacuation is usually recommended for treatment.vesicular molle 1
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Gestational trophoblastic disease refers to a spectrum of conditions that result from abnormal proliferation of trophoblast tissue. This includes complete and partial hydatidiform moles, as well as invasive moles and choriocarcinoma. Complete moles are characterized by marked trophoblastic proliferation and swelling of the chorionic villi, resulting in vesicles within the uterus. The document discusses the incidence, pathology, diagnosis, treatment and follow up of molar pregnancies. Surgical evacuation is usually performed, and long term follow up is needed to monitor for recurrence and the potential development of choriocarcinoma.Sexually Transmitted Infections
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This document summarizes screening guidelines and methods for detecting female genital tract malignancies. It discusses screening criteria and validity, risk factors and epidemiology for cervical, endometrial, ovarian and vulvar cancers. Alternative screening methods to Pap smears like visual inspection with acetic acid and HPV testing are described. Guidelines are provided for breast, cervical and endometrial cancer screening intervals.vaginal prolapse
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This document discusses the management of genital prolapse. It defines prolapse and describes its causes as weakness of the pelvic supports. It outlines various types of prolapse and treatments including non-surgical options like pessaries and pelvic floor exercises, as well as surgical procedures like anterior and posterior colporrhaphy, sling operations, and abdominal and laparoscopic surgeries. The document emphasizes that surgery should be tailored to the individual patient and aims to both correct defects and meet their requirements.prevention Cervical cancer
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Cervical cancer is a major public health problem that is largely preventable. It is the third most common cancer in women worldwide, with over 500,000 new cases and 200,000 deaths each year. While often asymptomatic in early stages, if detected early through screening it can be treated effectively. Screening allows for detection and treatment of precancerous lesions before they develop into invasive cancer. The document discusses the causes, risk factors, natural history, screening methods such as Pap smear and visual inspection with acetic acid, diagnostic tools, and treatment options including ablation, excision and hysterectomy for prevention and management of cervical cancer.ovarian tumor
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The document provides an overview of epithelial ovarian tumours, which make up 90% of ovarian tumours. They most commonly originate from the coelomic epithelium. The four main histological types are serous, mucinous, endometrioid, and clear cell. Risk factors include increased age, family history, and lack of pregnancy. Screening and tumor markers like CA125 are used for early detection but have limitations. Surgery is the main treatment and chemotherapy is used for advanced stages. Prognosis depends on stage, with 5-year survival rates ranging from 76-93% for stage 1 to 11% for stage 4.Contemporary Use of the Pessary
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The document provides an overview of pessary use, including their historical origins, types, fitting procedures, and care instructions. It discusses various pessary designs and their uses for conditions like uterine prolapse, cystocele, rectocele, urinary incontinence, and cervical incompetence. Guidelines are provided on patient education, fitting procedures, follow-up care, and reimbursement codes.management of cancer of cervix
management of cancer of cervixKarl Daniel, M.D.
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The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.leiomyomas
leiomyomasKarl Daniel, M.D.
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The document summarizes guidelines for the management of uterine leiomyomas (fibroids). It discusses various treatment options including medical management with drugs like GnRH agonists, and surgical options like hysterectomy, myomectomy (surgical removal of fibroids), and newer minimally invasive options like uterine artery embolization and laparoscopic myolysis (coagulation of fibroids). It provides details on the risks, benefits, and evidence for each approach and notes that treatment should be individualized based on a woman's symptoms and desire for fertility.fibroids
fibroidsKarl Daniel, M.D.
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Leiomyoma, commonly known as uterine fibroids, are benign smooth muscle tumors of the uterus that are the most common tumors of the female pelvis. They occur most frequently in women during their childbearing years. While the exact causes are unknown, risk factors include high estrogen levels. Leiomyomas can be classified based on their location within the uterus as submucosal, subserosal, or intramural. Magnetic resonance imaging is the most accurate imaging technique for detecting and classifying leiomyomas. Treatment options depend on factors such as a patient's age, parity, symptoms, and the size and location of the fibroids and include conservative approaches, medications, uterine artery embolization,endometriosis
endometriosisKarl Daniel, M.D.
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Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum. It causes pain and infertility and is most common during reproductive years. Theories for its cause include retrograde menstruation and genetic/immunological factors. Diagnosis involves symptoms, exam, laparoscopy, and imaging. Treatment options include pain medications, hormonal therapy like combined oral contraceptives or GnRH agonists, and surgery to remove lesions. While not curable, treatment aims to control pain and improve fertility.DnC
DnCKarl Daniel, M.D.
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Surgical abortion is a generally safe procedure that has become significantly safer since the Roe v. Wade decision legalized abortion in 1973. Techniques for early abortions include suction curettage and medical abortion for pregnancies under 14 weeks. For later abortions between 14-24 weeks, dilatation and evacuation is commonly used. While complications are infrequent, they can occasionally be serious, so follow-up after the procedure is important.carcinoma vulva
carcinoma vulvaKarl Daniel, M.D.
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The document discusses different types of malignant tumors that can occur on the vulva, with the most common being squamous cell carcinoma. It describes the histological classification and grading of vulvar carcinomas. Vulvar squamous cell carcinoma is often preceded by vulvar intraepithelial neoplasia and can be divided into HPV-associated and HPV-unassociated types based on etiology and presentation. Prognosis depends on tumor size, depth of invasion and lymph node involvement.amenorrhea
amenorrheaKarl Daniel, M.D.
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This clinical guideline outlines an approach for evaluating and managing amenorrhea. It defines primary and secondary amenorrhea and discusses various pathophysiologies including anovulatory and ovulatory causes. The approach involves obtaining a thorough history, physical exam, and initial tests to rule out pregnancy and cryptomenorrhea. Based on exam and test results, patients are categorized to guide further workup and diagnosis of conditions like hypothalamic-pituitary dysfunction, PCOS, ovarian failure, mullerian agenesis, and congenital adrenal hyperplasia. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues from estrogen deficiency. Frequent re-evaluation is often needed given the complexity ofadenomyosis
adenomyosisKarl Daniel, M.D.
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The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.Evidence Based Diagnosis
Evidence Based DiagnosisKarl Daniel, M.D.
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The document discusses key concepts for evaluating diagnostic tests and techniques, including sensitivity, specificity, predictive values, and likelihood ratios. It emphasizes that diagnostic tests need to be evaluated based on their relevance, validity, and ability to help clinicians care for patients. New diagnostic tests should be properly evaluated through clinical studies using gold standard references and accounting for prevalence, blinding, and independent application of the reference standard before being adopted into routine care.HORMONE REPLACEMENT THERAPY 2
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This document discusses hormone replacement therapy (HRT) for menopause. It lists common menopausal symptoms like hot flashes, night sweats, and mood changes. It describes the hormones and drugs used in HRT, including estrogens, progestogens, and tibolone. It discusses routes of treatment administration and strategies for HRT. It also outlines risks of HRT, like increased breast cancer risk, and contraindications for HRT like previous blood clots or impaired liver function.