Update on Gender-Affirming Treatment for the Transgender Woman

2017 ◽  
Vol 35 (05) ◽  
pp. 442-447 ◽  
Author(s):  
Cecile Unger
Keyword(s):  
Health Care Providers ◽  
Preoperative Evaluation ◽  
Postoperative Management ◽  
Transgender Women ◽  
Standards Of Care ◽  
Care Providers ◽  
Advantages And Disadvantages ◽  
Individual Assessment ◽  
Term Data

AbstractTransgender women often transition with cross-sex hormone therapy and some opt to further affirm themselves with breast augmentation, facial feminization procedures, and/or vaginoplasty surgery. When considering medical and surgical transition for the transgender woman, careful preoperative evaluation and individual assessment is imperative and the World Professional Association for Transgender Health (WPATH) Standards of Care provide the framework from which health care providers and surgeons may assess eligibility for affirming treatments. Vaginoplasty for the transgender woman may be performed by a variety of techniques, mainly penile inversion vaginoplasty or intestinal segment vaginoplasty. Surgical outcomes vary according to technique, and the unique risks, advantages, and disadvantages must be considered. Outcomes appear to be satisfactory following vaginoplasty surgery, but prospective, long-term data are still lacking. Providers should be aware of the peri- and postoperative management of the transgender women after genital surgery, as many women require ongoing care and management after surgery.

Multimorbidity, Consumer-Directed Care, and Drug-Related Harm

2021 ◽  
Vol 36 (3) ◽  
pp. 125-126
Author(s):  
Chris Alderman
Keyword(s):  
Health Care Providers ◽  
Developed Countries ◽  
Care Practice ◽  
Care Providers ◽  
Term Care ◽  
Societal Challenges ◽  
Psychiatric Conditions ◽  
New Treatments ◽  
Related Harm

People from developed countries around the world now routinely live into their 80s and beyond, and this is associated with a range of medical and societal challenges that must be addressed. It is relatively rare to encounter older people who are not affected by one or more chronic diseases, including conditions such as osteoarthritis, gastroesophageal reflux disease (GERD), hypertension, and depression. The concurrence of a number of medical and/or psychiatric conditions in the same patient has come to be referred to as multimorbidity, and it is a particularly familiar phenomenon observed by health care providers in settings such as the Emergency Department (ED), primary care practice, and long-term care facilities. Given that life expectancy continues to increase, and that there is considerable further investment in research for the development of new treatments, which will achieve adoption and be promoted to consumers, it is clear that multimorbidity is likely to be a driver for problems arising from medications that are vigorously promoted to consumers.

Depression: A Long-Term Illness

1994 ◽  
Vol 165 (S26) ◽  
pp. 9-15 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Maintenance Treatment ◽  
Depressive Disorders ◽  
Care Providers ◽  
Serious Illness ◽  
Antidepressant Treatments ◽  
Continued Education ◽  
Low Levels

The realisation that major depression is often both chronic and recurrent has slowly begun to change the way that depression is diagnosed and treated. In particular, the need for continuation and maintenance treatment is an issue that now deserves increased attention, especially with the availability of new classes of antidepressant treatments, which have excellent efficacy and more favourable side-effect profiles. Although the serious consequences of depressive disorders clearly indicate the need for effective and prompt intervention on the part of clinicians, the results of several studies indicate that patients with depression consistently receive no or low levels of antidepressant therapy. It is hoped that, through continued education of health care providers and patients about the consequences of depression, the issue of undertreatment of this serious illness will be resolved.

scholarly journals “Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242604
Author(s):  
Marian Loveday ◽  
Sindisiwe Hlangu ◽  
Jennifer Furin
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Health Care System ◽  
Health Care Providers ◽  
Physical Symptoms ◽  
Coding System ◽  
Care Providers ◽  
Convenience Sample ◽  
Care System

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

scholarly journals Non-invasive prenatal testing: what an obstetrician needs to know

2020 ◽  
Vol 9 (12) ◽  
pp. 5200
Author(s):  
Mishu Mangla
Keyword(s):  
Health Care Providers ◽  
Prenatal Screening ◽  
Prenatal Testing ◽  
High Sensitivity ◽  
Target Population ◽  
Care Providers ◽  
Advantages And Disadvantages ◽  
Non Invasive ◽  
Primary Health Care Providers ◽  
First Choice

No field in obstetrics has seen such fast advancement, as the field of prenatal screening and diagnosis. A wide variety of tests are available today, and this at times becomes confusing both for the patient and the treating doctor that which screening test would be best suited in the given circumstances. Non-invasive prenatal screening, with its numerous advantages is rapidly becoming the test of first choice, especially in the affording set of population.  Although, the test has a very high sensitivity and a very good positive predictive value, this too suffers from some disadvantages which should be clear to the obstetrician ordering the test. A good knowledge about the test, the ideal target population in which this should be offered as the primary screening tool and limitations of the test should be known to all practicing obstetricians and primary health care providers. The current review aims to provide a simplified and updated knowledge regarding non-invasive prenatal testing (NIPT), its major advantages and disadvantages and summarizes the role of ultrasound in patients with negative NIPT.

Current Challenges in Cystic Fibrosis Screening

2003 ◽  
Vol 127 (9) ◽  
pp. 1133-1139 ◽  
Author(s):  
Elaine Lyon ◽  
Christine Miller
Keyword(s):  
Cystic Fibrosis ◽  
Health Care Providers ◽  
Patient Information ◽  
Phenotypic Expression ◽  
Gene Mutations ◽  
Care Providers ◽  
Idiopathic Pancreatitis ◽  
Advantages And Disadvantages ◽  
Bilateral Absence ◽  
Cf Transmembrane Conductance Regulator

Abstract Content.—This article gives an overview of the symptoms and mutations associated with classic and atypical cystic fibrosis (CF). Current testing methods for mutation detection in CF are discussed. Objectives.—Review testing for CF, including American College of Medical Genetics and American College of Obstetrics and Gynecology guidelines and recommendations regarding population screening for CF. Describe symptomatic and mutational differences between patients with classic CF and atypical CF, including monosymptomatic conditions such as congenital bilateral absence of the vas deferens, idiopathic pancreatitis, and chronic sinusitis. Explain the concern about predicting the phenotypic expression of the condition from the genotype. Discuss the challenges of CF testing, including the preanalytic, analytic, and postanalytic phases. List the current methods for detecting CF transmembrane conductance regulator gene mutations, specifying the advantages and disadvantages of each. Describe the basic patient information necessary for laboratories to provide accurate risk assessments, such as ethnicity and family history, and reasons for the test being conducted (carrier or affected status). Results.—The technical challenges of detecting the 25 recommended mutations are being met by commercially available reagents. Challenges remain for the preanalytic and postanalytic phases. Only with accurate patient information can laboratories provide specific risk reductions on the basis of a negative genetic test result. Conclusion.—As health care providers become better informed about the recommendations for CF testing and laboratories continue to increase the sensitivities of their assays, patients will benefit from increased screening efficiency and accuracy. This will allow affected individuals to receive prompt and effective treatment and carriers to enjoy an expanded number of reproductive options.

Abstract WP408: Tacls: Taking Action for Optimal Community and Long Term Stroke Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Theresa L Green ◽  
Patrice Lindsay
Keyword(s):  
Health Care ◽  
Acute Stroke ◽  
Health Care Providers ◽  
Stroke Care ◽  
Residential Aged Care ◽  
Stroke Survivors ◽  
Care Providers ◽  
Community Based ◽  
Taking Action

Introduction: In Canada, approximately 12% of acute stroke patients are admitted to long-term care (LTC; or residential aged care) facilities following an acute stroke event. An additional 20-30% of patients are discharged home from hospital with referral for community-based homecare. Training programs for health care providers in these settings is variable and at times inconsistent with best practices. Internationally, focus is now shifting from a predominant inpatient acute care focus, to one encompassing ongoing care and support in the community for people living with stroke. In 2015, an educational resource called Taking Action for Optimal Community & Long Term Stroke Care (TACLS) was launched across Canada to ensure the appropriate knowledge and skills of front line care providers for stroke survivors in community and LTC facilities; the focus of this resource is on rehabilitation and recovery. Methods: The purpose of this interactive session is to introduce the TACLS resource and to engage health professionals in an examination of current international community based rehabilitation and recovery programs. The discussion/workshop will allow participants to examine, compare and contrast components of the TACLS program with programs being developed or offered elsewhere. Results: As health care providers helping stroke survivors live well and longer means investing in the use of best practice tools and resources that fit the local context and organizational practices. Bringing together international opinions and observations around post-stroke community care will allow cross-collaboration and inter-professional networking opportunities that ultimately will benefit patients living with stroke in community based settings. Discussion: As care shifts from hospital to community based settings, the importance of tools available to support stroke survivors in this area of the care continuum is essential. In Canada, utilizing the HSF education resource (TACLS) provides information to support community based health care providers working with people who have had a stroke in helping them achieve optimal outcomes, regain their best level of functioning, and live meaningful lives.

scholarly journals Visual process maps to support implementation efforts: a case example

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Jennifer Kononowech ◽  
Zach Landis-Lewis ◽  
Joan Carpenter ◽  
Mary Ersek ◽  
Robert Hogikyan ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Long Term Care ◽  
Process Mapping ◽  
Care Providers ◽  
Term Care ◽  
Goals Of Care ◽  
Process Maps ◽  
Time Burden ◽  
Centered Care

Abstract Background Process mapping is often used in quality improvement work to examine current processes and workflow and to identify areas to intervene to improve quality. Our objective in this paper is to describe process maps as a visual means of understanding modifiable behaviors and activities, in this case example to ensure that goals of care conversations are part of admitting a veteran in long-term care settings. Methods We completed site visits to 6 VA nursing homes and reviewed their current admission processes. We conducted interviews to document behaviors and activities that occur when a veteran is referred to a long-term care setting, during admission, and during mandatory VA reassessments. We created visualizations of the data using process mapping approaches. Process maps for each site were created to document the admission activities for each VA nursing home and were reviewed by the research team to identify consistencies across sites and to identify potential opportunities for implementing goals of care conversations. Results We identified five consistent behaviors that take place when a veteran is referred and admitted in long-term care. These behaviors are assessing, discussing, decision-making, documenting, and re-assessing. Conclusions Based on the process maps, it seems feasible that the LST note and order template could be completed along with other routine assessment processes. However, this will require more robust multi-disciplinary collaboration among both prescribing and non-prescribing health care providers. Completing the LST template during the current admission process would increase the likelihood that the template is completed in a timely manner, potentially alleviate the perceived time burden, and help with the provision of veteran-centered care.

scholarly journals “Beyond Personal Beliefs”

SAGE Open ◽  
2016 ◽  
Vol 6 (4) ◽  
pp. 215824401667271 ◽  
Author(s):  
Maria Giulia Olivari ◽  
Gaia Cuccì ◽  
Emanuela Confalonieri
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Family Health ◽  
Job Attitudes ◽  
Main Theme ◽  
Care Providers ◽  
Personal Beliefs ◽  
Structured Interviews ◽  
Adolescent Patients

Using a qualitative method, our study aims to explore, identify, and describe Italian health care providers’ reflections on the contraceptive behaviors of adolescents attending family health centers, and health care providers’ self-perception of their own job attitudes toward these adolescent patients. Semi-structured interviews with 46 Italian health care providers were conducted and analyzed using thematic analysis. Two main themes emerged from the thematic data analysis regarding Italian health care providers’ self-perceptions and reflections. The first main theme was labeled “adolescents’ contraceptive behavior” and included two subthemes: “adolescents are confused and unprepared” and “contraception is a girls’ responsibility.” The second theme was labeled “job attitudes with adolescents,” and included three subthemes: “to inform and to educate,” “to build trustful relationships,” and “to go beyond personal beliefs.” The findings of this study showed that Italian health care providers perceive themselves as nonjudgmental and they interpret their own behavior as an attempt to answer adolescents’ sexual and reproductive health (SRH) needs in an open-minded way. Their work with adolescent patients with relation to contraceptive behaviors is led by the desire to educate through building a significant and long-term relationship that could sustain these patients.

Family, Friends and Neighbors: The Role of Primary Groups in Preventing the Misuse of Drugs

1989 ◽  
Vol 19 (2) ◽  
pp. 261-281 ◽  
Author(s):  
Barbara Lynn Kail ◽  
Eugene Litwak
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Theoretical Framework ◽  
Prescription Medicine ◽  
Care Providers ◽  
Minority Woman ◽  
Term Basis ◽  
Primary Groups

Primary groups such as relatives, neighbors and friends are a source of support that health care providers overlook. We present a theoretical framework which suggests primary groups can help prevent the misuse of prescription medicine. Kin are especially helpful in assisting elderly to take medications on a long-term basis where the regimens are fairly simple. It may also be especially important to engage kin in helping the older minority woman to understand the doctor. Even at a distance, kin may be able to provide such assistance and should not be discounted as a resource. Neighbors can be helpful in getting a medicine needed unexpectedly and might assist with relatively complex routines that last for only a brief period. Friends who have had similar experiences are especially helpful when the medicine is prescribed on an as needed basis by teaching the client how to judge when a dose is needed.

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