Development of Repository From a Pediatric Gender Clinic

Abstract Objectives: With the publication of updated guidelines for care of transgender and gender non-conforming individuals, there has been an increase in the presence of gender diversity in both mainstream media and medical literature. Several gaps currently exist in medical knowledge regarding long term effects of gender-affirming therapies. There is a lack of standardization in study design, patient sampling, and outcome measures, and most studies are retrospective. Here we describe the creation of both a retrospective and prospective repository of patients who presented to the Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric gender program. Methods: Baystate Medical Center is located in western MA and is a tertiary referral center. A pediatric gender clinic was created in 2014. A repository containing both retrospective and prospective data was approved by the UMass-Baystate IRB to include patients ages 2 to 24 years of age who presented to our gender clinic. Retrospective data was obtained using the McKesson billing database. Sociodemographic, clinical and behavioral health data were collected. We are consenting individuals as they present to the clinic for the prospective component. Those that have consented fill out a survey at each visit. The repository has been approved to follow outcome data for 25 years. Results: To date, we have 218 individuals in the repository, 75 of which are in the prospective component. Age of presentation ranged from 6 yrs to 24 yrs with an average age of 15 yrs. 62% identified as transmale, 31% as transfemale and the remainder as gender fluid or other. 75% have been prescribed gender affirming hormone therapy (56% GnRH agonist therapy, 20% estrogen, 58% testosterone). Of those being followed prospectively, 76% identified as white, 19% Hispanic. 79% were satisfied or very satisfied with their care. Conclusions: Here we describe the demographic and clinical characteristics of patients that have presented to our gender clinic since 2014. The creation of our gender repository will allow us to assess sociodemographic, clinical and behavioral health outcomes of treatment, including metabolic parameters, bone health, and mental health outcomes in our pediatric population. Future projects include assessment of the change in cardiovascular risk in individuals on gender-affirming hormone therapy.

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Stapled Intestinal Anastomosis in Neonates: Validation of Safety and Efficacy

The American Surgeon ◽

10.1177/000313481007600632 ◽

2010 ◽

Vol 76 (6) ◽

pp. 644-646 ◽

Cited By ~ 5

Author(s):

Jon D. Simmons ◽

Joseph W. Gunter ◽

Justin D. Manley ◽

David E. Sawaya ◽

Christopher J. Blewett

Keyword(s):

Small Bowel ◽

Gestational Age ◽

Medical Center ◽

Intestinal Anastomosis ◽

Outcome Data ◽

High Rate ◽

Average Weight ◽

Colon Anastomosis ◽

Long Term Effects ◽

Intestinal Anastomoses

The safety and effectiveness of a stapled intestinal anastomosis in adults and children is well documented. However, the role of this technique in neonates is not well validated. We report our experience with stapled intestinal anastomoses in the neonate at the University of Mississippi Medical Center. All patients from the neonatal intensive care unit who had a stapled intestinal anastomosis between February 2007 and May 2008 were identified. A stapled side-to-side functional end-to-end intestinal anastomosis was performed in all patients using a gastrointestinal anastomosis stapler. Demographic, management, and outcome data were collected via chart review. Variables collected included: birth weight, estimated gestational age at birth and surgery, weight at surgery, the use of vasopressors, associated diagnoses, location of the anastomosis, and postoperative clinic visits. A total of 18 patients were identified during the study period. Nine had small bowel to small bowel, eight had ileum to colon, and one had a colon to colon anastomosis. The average weight at time of operation was 2.8 kilograms (Kg) and the average estimated gestational age at surgery was 38.7 weeks. The only complication reported was a partial small bowel obstruction on postoperative day 12, which was successfully treated nonoperatively. Two patients died from problems not associated with the anastomosis. There were no anastomotic leaks or strictures. The literature regarding the use of stapled bowel anastomoses in neonates is scant. Stapled intestinal anastomoses can be performed safely in neonates without a high rate of complication. The long term effects of stapled intestinal anastomoses in the neonate are unknown. Future areas of interest would include effects on postoperative feeding and operative time.

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Faculty Opinions recommendation of Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718127376.793484657 ◽

2013 ◽

Cited By ~ 1

Author(s):

Pagona Lagiou

Keyword(s):

Health Outcomes ◽

Hormone Therapy ◽

Women’S Health ◽

Women's Health ◽

Randomized Trials ◽

Menopausal Hormone Therapy ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

The Women’S Health Initiative

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Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

Military Medicine ◽

10.1093/milmed/usab044 ◽

2021 ◽

Author(s):

Robert P Lennon ◽

Theodore J Demetriou ◽

M Fahad Khalid ◽

Lauren Jodi Van Scoy ◽

Erin L Miller ◽

...

Keyword(s):

New York ◽

Medical Center ◽

Academic Medical Center ◽

Military Medicine ◽

Case Series ◽

Outcome Data ◽

Urban Environments ◽

Urban Setting ◽

Published Data ◽

Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

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Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation

Journal of Primary Care & Community Health ◽

10.1177/2150132721996888 ◽

2021 ◽

Vol 12 ◽

pp. 215013272199688

Author(s):

Ajeng J. Puspitasari ◽

Dagoberto Heredia ◽

Elise Weber ◽

Hannah K Betcher ◽

Brandon J. Coombes ◽

...

Keyword(s):

Anxiety Disorder ◽

Health Services ◽

Behavioral Health ◽

Psychiatric Symptoms ◽

Medical Center ◽

Academic Medical Center ◽

Management Training ◽

The United States ◽

Behavioral Health Services ◽

Perinatal Women

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

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Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1730083 ◽

2021 ◽

Vol 5 (02) ◽

pp. 091-098

Author(s):

James F. Pike ◽

William F. Abel ◽

Tyler B. Seckel ◽

Christine M.G. Schammel ◽

William Flanagan ◽

...

Keyword(s):

Prostate Volume ◽

Medical Center ◽

Specific Antigen ◽

Outcome Data ◽

Artery Embolization ◽

Prostatic Artery Embolization ◽

Optimal Care ◽

International Prostatic Symptom Score ◽

Simple Prostatectomy ◽

Prostatic Artery

Abstract Purpose Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for patients with prostates >80 mL and has demonstrated lower morbidity rates. We sought to evaluate PAE at a single tertiary medical center. Methods A retrospective review of all patients who underwent PAE was completed. Demographic, clinicopathologic, procedure, and outcome data were collected to include international prostatic symptom score (IPSS) and quality of life (QoL) assessments. Results The pre-PAE mean prostate-specific antigen (PSA) was 8.4 ng/mL, mean prostate volume was 146.9 mL (9% >200 mL), and mean postvoid residual (PVR) was 208.2 mL (21.9% 200–300 mL). IPSS mean was 19.8 and QoL was “mostly dissatisfied.” Following PAE, mean PSA was reduced by 3.2 ng/mL (38.1%, p = 0.3014), the mean prostate volume reduction was 59.2 mL (40.3%, n = 19, p < 0.0001), and the average PVR reduction was 150.3 mL (72.2%, n = 27, p = 0.0002). Average IPSS score was also lower (11.9; 60.1%, n = 25, p < 0.0001) and QoL was reduced to “mostly satisfied” (p < 0.0001). Technical success was 100% with 24% minor morbidities. Conclusion PAE is a successful treatment for patients with BPH resulting in large prostates that are not good candidates for simple prostatectomy, providing optimal care with less operative and postoperative complications.

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The Ten Point Clock Test: A Quick Screen and Grading Method for Cognitive Impairment in Medical and Surgical Patients

The International Journal of Psychiatry in Medicine ◽

10.2190/5a0f-936p-vg8n-0f5r ◽

1994 ◽

Vol 24 (3) ◽

pp. 229-244 ◽

Cited By ~ 144

Author(s):

Peter J. Manos ◽

Rae Wu

Keyword(s):

Cognitive Impairment ◽

Cognitive Deficits ◽

Neuropsychological Tests ◽

Medical Center ◽

Neuropsychological Test ◽

Hospitalized Patients ◽

Surgical Patients ◽

Tertiary Referral Center ◽

The Mean ◽

State Examination

Objective: The objective of this study was to evaluate the clinical utility of the ten point clock test in screening for and grading cognitive deficits in medical and surgical patients. Method: The setting was the hospital and clinics of Virginia Mason Medical Center, a tertiary referral center. Consecutive samples of hospitalized patients, and clinic outpatients—with and without a dementia—were administered the ten point clock test as well as a number of other neuropsychological tests and measures of cognitive impairment. Results: Clock scores correlated with neuropsychological test scores and with the mini-mental state examination. They were stable from rater to rater, and from day to day in stable patients. The mean clock score of elderly outpatient controls was 8.5, significantly different from the mean of 5.5 scored by patients with a dementia. A cut off score of seven identified 76 percent of outpatients with dementia and 78 percent of elderly controls. Clock scores correlated well with nurses' ratings of their inpatients' cognitive deficits (Spearman's rs = −0.61). The test was easy to administer, even to hospitalized patients. Conclusions: The ten point clock test is reliable, valid, and useful as a quick screen and grading method for cognitive deficits in medical and surgical patients.

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Environmental racialisation and poetics of influence in the postgenomic era: fire, soil, spirit

Medical Humanities ◽

10.1136/medhum-2020-012061 ◽

2021 ◽

pp. medhum-2020-012061

Author(s):

Lara Choksey

Keyword(s):

Health Outcomes ◽

Human Life ◽

Time And Space ◽

Environmental Racism ◽

Politics Of Difference ◽

Material Environment ◽

Liberal Humanism ◽

Influence At Work ◽

The Creation ◽

Genetic Reductionism

This article considers processes of environmental racialisation in the postgenomic era through their politics of difference and poetics of influence. Subfields like epigenetics promise to account for a plurality of possible influences on health outcomes. While this appears to present possibilities for historical reparation to communities whose epigenomes may have been chronically altered by histories of violence and trauma, the prevailing trend has been to compound processes of racialisation in the reproduction of good/bad environments. The postgenomic era has promised an epistemological transformation of ideas and values of human life, but its practices, technologies and ideology have so far prevented this. Epigenetics, rather, reproduces biomedical exclusions through imaginaries of embodied contexts, methods of occlusion and hypervisibility, and assignations of delay and deviance. This is more complex than both genetic reductionism and environmental racism: studies on epigenetics reveal a poetics of influence at work under liberal humanism complicit in the creation of death-worlds for racialised populations. Other experiments with life are possible and unfolding: Jay Bernard’s poem ‘Chemical’, set in the aftermath of London’s Grenfell Tower fire in 2017, unmoors its bodies from material environment, offering a spectral configuration of collective life. This configuration involves negotiating with the fixing of time and space on which genomic imaginaries depend.

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Longitudinal Links between Income Dynamics and Young Adult Socioeconomic and Behavioral Health Outcomes

Youth & Society ◽

10.1177/0044118x21996382 ◽

2021 ◽

pp. 0044118X2199638

Author(s):

Kendra Whitfield ◽

Laura Betancur ◽

Portia Miller ◽

Elizabeth Votruba-Drzal

Keyword(s):

Young Adult ◽

Health Outcomes ◽

Behavioral Health ◽

Low Income ◽

Family Income ◽

Adult Outcomes ◽

Income Volatility ◽

Income Loss ◽

Socioeconomic Outcomes ◽

Young Adult Outcomes

Longitudinal links between childhood family income and adult outcomes are well documented. However, research on childhood income volatility and young adult outcomes is limited. This study utilizes data from the NLSY ( N = 6,410) to examine how childhood family income and income volatility relate to socioeconomic outcomes and mental/behavioral health in emerging adulthood. Results show that lower childhood income was associated with young adult socioeconomic and behavioral health outcomes. Higher income volatility was associated with increased depression and teen parenthood during young adulthood. Additional analyses examining trajectories of income volatility illustrated that children in families with unstable income trajectories (i.e., frequent income losses and gains) showed higher depression scores than those with stable trajectories. These findings suggest that income volatility, not just income level or income loss, is important to consider when studying economic disparities in young adult outcomes. Implications for policies and programs for low-income, high-volatility households are discussed.

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