scholarly journals Forever young? The ethics of ongoing puberty suppression for non-binary adults

2020 ◽  
Vol 46 (11) ◽  
pp. 743-752 ◽  
Author(s):  
Lauren Notini ◽  
Brian D Earp ◽  
Lynn Gillam ◽  
Rosalind J McDougall ◽  
Julian Savulescu ◽  
...  
Keyword(s):  
Well Being ◽  
Sex Characteristics ◽  
The Novel ◽  
Goals Of Medicine ◽  
Specific Patient ◽  
Secondary Sex Characteristics ◽  
Puberty Suppression ◽  
Long Term Follow Up ◽  
Potential Benefits

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.

scholarly journals Breast Cancer during Pregnancy—Current Paradigms, Paths to Explore

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1669 ◽  
Author(s):  
Ayelet Alfasi ◽  
Irit Ben-Aharon
Keyword(s):  
Breast Cancer ◽  
Well Being ◽  
Developed Countries ◽  
Lymph Node Biopsy ◽  
Current Data ◽  
Long Term Effects ◽  
Long Term Outcomes ◽  
Risk Benefit Assessment ◽  
Long Term Follow Up

Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate balance of risks and benefits for both maternal and fetal well-being. Currently, there is paucity of data regarding the short- and long-term outcomes of in-utero exposure to anti-neoplastic agents. In general, when possible, treatment for PABC should follow the same guidelines as in non-pregnant patients. Surgery, including sentinel lymph node biopsy, is possible during all trimesters of pregnancy. Radiotherapy is contraindicated during pregnancy, although it might be considered in highly selected patients based on risk–benefit assessment. Evidence supports that administration of chemotherapy may be safe during the second and third trimesters, with cessation of treatment three weeks prior to expected delivery. Currently, hormonal therapy and anti-HER2 agents are contraindicated during pregnancy and should be postponed until after delivery. Prematurity is associated with worse neonatal and long-term outcomes, and thus should be avoided. While current data on the long-term effects of anti-neoplastic treatments are reassuring, grade of evidence is lacking, hence additional large prospective studies with long-term follow-up are essential to rule out any treatment-induced adverse effects.

scholarly journals Psychedelics and potential benefits in “healthy normals”: A review of the literature

2019 ◽  
Vol 3 (3) ◽  
pp. 280-287 ◽  
Author(s):  
Sam Gandy
Keyword(s):  
Psychological Functioning ◽  
Well Being ◽  
Future Research ◽  
Life Meaning ◽  
Potential Development ◽  
Potential Benefits ◽  
High Doses ◽  
And Behavior

We are in the midst of a psychedelic research renaissance. With research examining the efficacy of psychedelics as a treatment for a range of mental health indications still in its early stages, there is an increasing body of research to show that careful use of psychedelics can yield a variety of benefits in “healthy normals” and so lead to “the betterment of well people.” Psychedelics have been found to modulate neuroplasticity, and usage in a supportive setting can result in enduring increases in traits such as well-being, life satisfaction, life meaning, mindfulness, and a variety of measures associated with prosocial behaviors and healthy psychological functioning. The effect of psychedelic experience on measures of personality trait openness and is potential implications is examined, and the potential role of awe as a mediator of the benefits of the psychedelic experience is discussed. Special attention is given to the capacity of psychedelics to increase measures of nature relatedness in an enduring sense, which is being correlated with a broad range of measures of psychological well-being as well as a key predictor of pro-environmental awareness and behavior. The effects of particular classical psychedelic compounds on healthy people are discussed, with special attention given to the mystical-type experiences occasioned by high doses of psychedelics, which appear to be an important mediator of long-term benefits and psychotherapeutic gains. Research looking at the potential benefits of psychedelic microdosing is discussed. Potential future research avenues are explored, focusing on the potential development of psychedelics as agents of ecotherapy.

Orsiro: ultrathin bioabsorbable polymer sirolimus-eluting stent

2019 ◽  
Vol 15 (4) ◽  
pp. 295-300 ◽  
Author(s):  
Ofer Kobo ◽  
Ariel Roguin
Keyword(s):  
Clinical Performance ◽  
Drug Eluting Stents ◽  
Bioabsorbable Polymer ◽  
Coronary Syndrome ◽  
Long Term Follow Up ◽  
Potential Benefits ◽  
Drug Eluting ◽  
Sirolimus Eluting Stent

Recent stent developments aimed to reduce and eliminate the long-term inflammatory response include thinner struts, modifications to stent design and the development of bioresorbable polymers (BP). We aimed to summarize the main findings and to discuss the established and the potential benefits of the Orsiro BP sirolimus-eluting stents in everyday clinical use. We have reviewed the available evidence on the clinical performance of the Orsiro BP drug-eluting stents. Orsiro BP sirolimus-eluting stents is clinically proven and showed noninferiority against major drug-eluting stents and provides high safety and efficacy profile at long-term follow-up. Furthermore, it may be the preferred treatment option in specific subgroups as acute coronary syndrome, as shown in the BIOFLOW V trial.

scholarly journals Antiretroviral Drug-Associated Oral Lichenoid Reaction in HIV Patient: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Pratanporn Arirachakaran ◽  
Mattana Hanvanich ◽  
Piyanad Kuysakorn ◽  
Kobkan Thongprasom
Keyword(s):  
Well Being ◽  
Fluocinolone Acetonide ◽  
First Case ◽  
Oral Pain ◽  
Antiretroviral Drug ◽  
Long Term Follow Up ◽  
Subsequent Withdrawal

Antiretroviral therapy has changed the course of HIV disease and improved quality of life in HIV patients. Incidence of an oral lichenoid drug reaction induced by zidovudine is not common. Once it occurs, it affects a patient's well being, in particular their oral functions. Here we report the first case of a 34-year-old Thai man with painful erosive lesions involving the lip and buccal mucosa. Treatment with topical fluocinolone acetonide 0.1% alleviated the patient's oral pain, but it was not until the subsequent withdrawal of zidovudine that the patient showed improvement and resolution of the lesions. Long-term follow-up was useful in the management of this patient, and no recurrence of the lesion was found during 21-month follow-up in this patient.

scholarly journals Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

2020 ◽  
Vol 08 (06) ◽  
pp. E733-E737 ◽  
Author(s):  
Takeshi Ogura ◽  
Nobu Nishioka ◽  
Masanori Yamada ◽  
Tadahiro Yamada ◽  
Saori Ueno ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
The Novel ◽  
Technical Success ◽  
Long Term Follow Up ◽  
Secondary Endpoints ◽  
Patient Refusal ◽  
A Prospective Study

Abstract Background and study aims A novel fine-gauge electrocautery dilator (ED) has recently become available in Japan. The current study evaluated the safety and feasibility of transluminal antegrade dilation for hepaticojejunal stricture (HJS) using this novel ED. Patients and methods Patients who with complicated HJS were retrospectively enrolled. The primary and secondary endpoints of this study were rates of technical success defined as functional antegrade HJS dilation using the novel ED and types of adverse events, respectively. A total of 22 patients were enrolled. Among them, six were treated using an enteroscopic approach due to the absence of bile duct dilation or patient refusal to undergo EUS-HGS. Therefore, 16 patients underwent EUS-HGS. Results The procedure was successful in 15 of 16 patients (93.8 %). The contrast medium flowed from the intrahepatic bile duct to the intestine of 14 of 15 patients (93.3 %). The resolution rate of HJS was 13 of 14 (92.9 %) at 6 months. Conclusion Our technique might offer a new option with which to treat HJS, although a prospective study with long-term follow-up is needed.

scholarly journals Survivors of the Piper Alpha oil platform disaster: long-term follow-up study

2002 ◽  
Vol 181 (5) ◽  
pp. 433-438 ◽  
Author(s):  
Alastair M. Hull ◽  
David A. Alexander ◽  
Susan Klein
Keyword(s):  
Well Being ◽  
Survivor Guilt ◽  
Post Traumatic Stress ◽  
Factors Affecting ◽  
Major Disaster ◽  
Long Term Follow Up ◽  
Post Traumatic ◽  
Definition Of ◽  
Specific Symptoms

BackgroundThe long-term psychological effects of surviving a major disaster are poorly understood. We undertook a survey of survivors of the Piper Alpha oil platform disaster (1988).AimsTo examine the role of factors relating to the trauma, the survivors and the survivors' circumstances.MethodTen years after the disaster, 78% (46/59) of the survivors were located, of whom 72% (33/46) agreed to be interviewed. A further three individuals completed postal measures.ResultsThe most stringent diagnostic criteria for post-traumatic stress disorder (PTSD) were met by 21% (7/33) of the survivors over 10 years after the disaster. Features such as physical injury, personal experience and survivor guilt were associated with significantly higher levels of post-traumatic symptoms.ConclusionsA narrow definition of factors affecting outcome will limit the potential for improving survivor well-being in the long-term after major disasters. Specific symptoms that are not included in the criteria for the diagnosis of PTSD, together with issues such as re-employment, need to be addressed.

Neurocognitive outcomes in children following immersion: a long-term study

2018 ◽  
Vol 103 (8) ◽  
pp. 784-789
Author(s):  
Maria Patricia Manglick ◽  
Frank I Ross ◽  
Mary-Clare Waugh ◽  
Andrew J A Holland ◽  
Daniel T Cass ◽  
...  
Keyword(s):  
Executive Function ◽  
Well Being ◽  
Near Drowning ◽  
Long Term Study ◽  
Neurocognitive Outcomes ◽  
Behavior Rating Inventory ◽  
Long Term Follow Up ◽  
Discharge From Hospital

ObjectiveTo investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital.DesignA prospective cohort study of near-drowning children.Setting95 drowning and near-drowning admissions, 0–16 years of age, from January 2009 to December 2013, to The Children’s Hospital at Westmead, Sydney, NSW, Australia.Participants23 children both met the criteria and had parental consent for the study.Main outcome measuresIdentification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3–6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF.Result95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study; 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up.ConclusionChildren admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.

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