Leiomyosarcoma of the esophagus is a very rare neoplasm, the total number of reported cases in the English literature being 44 patients. We describe another case of the esophageal leiomyosarcoma to add to the recorded experience of this rare tumor. The therapeutic and prognostic implications of the tumor are discussed, and the related literature is reviewed. In spite of the progress in the thoracic surgical care of patients and the progress in the field of oncology, overall prognosis of patients with leiomyosarcoma of the esophagus remains unchanged. Patients with polypoid lesions and well-differentiated histologic features appear to show better chance of survival. Simple excision of the lesion can be as effective as radical excision, especially in well-localized lesions.

As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new “Emergency Medicine Network” (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.

Objectives: Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians. Methods: We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability. Results: The TACTIC demonstrated good interrater reliability with an r 2 5 0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC 5 65%, 95% CI 54-76 v. postcourse TACTIC 5 84%, 95% CI 80-88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%. Conclusions: The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner's skill inserting chest tubes in a simulated setting. RÉ SUMÉObjectifs: Les médecins en mé decine d'urgence pé diatrique (MUP) ne procè dent pas souvent à la pose de drains thoraciques. Aussi avons-nous cherché à é laborer et à valider un instrument de notation visant à é valuer la compé tence relative à la pose de drains thoraciques, et à cerner les points faibles qui né cessiteraient une formation chez les mé decins en MUP.Mé thode: Nous avons é laboré un instrument d'é valuation portant sur 20 tâ ches et noté sur 40 points (0, 1, 2), appelé Tool for Assessing Chest Drain Insertion Competency (TACTIC), et avons é tudié les ré sultats de mé decins et de stagiaires en MUP relativement à la pose de drains thoraciques dans un modè le porcin de gril thoracique. Les participants ont é té é valué s au dé part, puis comparé s à euxmê mes aprè s une formation ciblé e, comportant des animations et des pré sentations sur le Web, un enseignement thé orique donné par des spé cialistes et la pratique de la pose de drains thoraciques sur des simulateurs passifs («task trainers»). Toutes les poses de drain ont é té enregistré es sur vidé o, puis examiné es par deux examinateurs tenus dans l'ignorance des faits. Huit vidé os courantes ont é té revues aux fins d'é valuation de la fiabilité interé valuateurs. Ré sultats: L'instrument TACTIC a obtenu de bons ré sultats au regard de la fiabilité interé valuateurs: r 2 5 0.86. De son cô té , la cohorte a connu une amé lioration sensible des ré sultats, selon la grille TACTIC (avant le cours: 65%; IC à 95%: 54-76; aprè s le cours: 84%, IC à 95%: 80-88), aprè s avo...

Primary care and sports medicine physicians are frequently consulted on medical clearance for prospective recreational divers. We discuss four common and controversial medical conditions--asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale--as they relate to fitness to dive. For each condition we review the relevant anatomy and physiology, current recommendations, and the pertinent medical literature. Finally, we offer evidence-based recommendations regarding fitness to dive for potential divers with these conditions.