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https://www.readbyqxmd.com/read/28332936/ethical-concerns-about-emerging-treatment-paradigms-for-gender-dysphoria
#1
Stephen B Levin
The increasing incidence of request for medical services to support gender transition for children, adolescents and adults has consequences for society, governmental institutions, schools, families, health care professionals, and, of course, patients. The sociological momentum to recognize and accommodate to trans phenomena has posed ethical dilemmas for endocrinologists, mental health professionals and sexual specialists as they experience within themselves the clash between Respect for Patient Autonomy, Beneficence, Nonmalficience, and Informed Consent...
March 23, 2017: Journal of Sex & Marital Therapy
https://www.readbyqxmd.com/read/28332774/changing-hpv-vaccination-rates-in-bisexual-and-lesbian-women
#2
Carolee Polek, Thomas Hardie
BACKGROUND: Human papillomavirus (HPV) vaccination rates continue to be below national targets for women and lower in some sexual minorities. HPV is a primary causal agent in cervical cancer, from which members of the lesbian and bisexual community mistakenly believe they are at low risk. This study characterized rates of HPV vaccination in women based on their sexual orientation. METHODS: Data were obtained from the Centers for Disease Control and Prevention's National Health Interview Survey 2013-2014...
March 23, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28332090/disparities-in-the-clinical-evolution-of-anal-neoplasia-in-an-hiv-infected-cohort
#3
Edward R Cachay, Wollelaw Agmas, Wm Christopher Mathews
BACKGROUND: A recent meta-analysis suggested that anal intraepithelial neoplasia and invasive anal cancer are more prevalent among black men having sex with men (MSM). METHODS: We conducted a retrospective cohort of HIV-infected adult patients under care between 2001 and 2012. Disparities in clinical evolution of anal intraepithelial neoplasia to high-grade squamous intraepithelial lesion (HSIL) and invasive anal cancer were evaluated in a three-state Markov model adjusted for cytology misclassification...
March 23, 2017: Journal of Racial and Ethnic Health Disparities
https://www.readbyqxmd.com/read/28331102/clinical-features-of-women-with-turner-syndrome-experiencing-transition-period-in-japan
#4
Satsuki Nishigaki, Takashi Hamazaki, Akitoshi Tsuruhara, Toshiko Yoshida, Takuji Imamura, Hiroshi Inada, Keinosuke Fujita, Haruo Shintaku
Turner syndrome results from the entire or partial loss of the second X chromosome, and is associated with a number of medical problems. Affected women require long-term medical follow-up. This study investigated the status of medical follow-up focusing on the transition for young adult women with Turner syndrome (TS). The clinical profiles of 63 women with TS over the age of 16 were retrospectively examined. Thirty-three women are continuously followed by pediatric endocrinologists at our pediatric division...
March 22, 2017: Endocrine Journal
https://www.readbyqxmd.com/read/28329352/costs-and-consequences-of-early-hospital-discharge-after-major-inpatient-surgery-in-older-adults
#5
Scott E Regenbogen, Anne H Cain-Nielsen, Edward C Norton, Lena M Chen, John D Birkmeyer, Jonathan S Skinner
Importance: As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective: To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions...
March 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28329212/clinical-status-of-adolescents-with-perinatal-hiv-at-transfer-to-adult-care-in-the-uk-ireland
#6
Intira Jeannie Collins, Caroline Foster, Anna Tostevin, Pat Tookey, Andrew Riordan, David Dunn, D M Gibb, Ali Judd
Background.: Increasing numbers of children infected perinatally with human immunodeficiency virus (HIV) are surviving to adolescence and transitioning to adult care, yet there are scarce data on their clinical status at transfer. Methods.: We analyzed prospective cohort data from the UK/Ireland national Collaborative HIV Pediatric Study (CHIPS). Clinical status at last pediatric clinic visit prior to transfer was described. Factors associated with higher CD4 cell count and viral load (VL) suppression<400 c/mL among patients on antiretroviral therapy (ART) at transfer were assessed using linear and logistic regression, respectively...
March 9, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28325798/management-of-inpatient-hyperglycemia-and-diabetes-in-older-adults
#7
Guillermo E Umpierrez, Francisco J Pasquel
Adults aged 65 years and older are the fastest growing segment of the U.S. population, and their number is expected to double to 89 million between 2010 and 2050. The prevalence of diabetes in hospitalized adults aged 65-75 years and over 80 years of age has been estimated to be 20% and 40%, respectively. Similar to general populations, the presence of hyperglycemia and diabetes in elderly patients is associated with increased risk of hospital complications, longer length of stay, and increased mortality compared with subjects with normoglycemia...
April 2017: Diabetes Care
https://www.readbyqxmd.com/read/28323335/surgical-guidelines-for-perioperative-management-of-older-adults-what-geriatricians-need-to-know
#8
Jessica L Colburn, Sanjay Mohanty, John R Burton
A multidisciplinary panel of experts representing surgery, anesthesia, and geriatrics recently published guidelines for surgeons on the optimal perioperative management of older adults, including recommendations on postoperative recovery and posthospital transitions of care. Geriatricians have an important role in the care for older adults in the preoperative period as older adults consider surgical options and prepare for surgical procedures, during the perioperative period as inpatient consultants, and in the postoperative period as older adults transition to rehabilitation facilities or to home...
March 21, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28322632/cost-effectiveness-of-a-care-transition-intervention-among-multimorbid-patients
#9
Lani Zimmerman, Fernando A Wilson, Myra S Schmaderer, Leeza Struwe, Bunny Pozehl, Audrey Paulman, Lisa C Bratzke, Kim Moore, Libby Raetz, Barb George
The purpose of this pilot study was to assess the cost-effectiveness of four different doses (based on patients' level of cognition and activation) of a home-based care transitions intervention compared with usual care at 2 and 6 months after hospital discharge to home for 126 adult patients with three or more chronic diseases. Health care utilization was measured, and a cost-effectiveness analysis was used to estimate incremental costs and quality-adjusted life-years associated with each intervention arm. At 6 months, results from this pilot study are very promising and support cost-effectiveness for Group 2-low cognition/high activation, Group 3-normal cognition/low activation, and Group 4-normal cognition/high activation patients...
October 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28318659/cardiovascular-and-general-health-status-of-adults-with-trisomy-21
#10
Samuel A Hayes, Shelby Kutty, Joshua Thomas, Joyce T Johnson, Anji T Yetman
BACKGROUND: Patients with Trisomy 21 are now living well into adulthood. Little data exists to assist the cardiologist in the care of these patients. We sought to examine the cardiac and general health status of adults with Trisomy 21 undergoing cardiac evaluation. METHODS & RESULTS: A retrospective review of all affected adults >21years followed at 2 tertiary care institutions was performed. Of 193 patients identified, median age was 31 (range 21.1-60.5) years...
March 10, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28318186/cross-cultural-adaptation-of-the-transition-readiness-assessment-questionnaire-to-argentinian-spanish
#11
Carmen L De Cunto, Alfredo Eymann, María de Los Ángeles Britos, Florencia González, Mariana Roizen, María de Las Mercedes Rodríguez Celin, Enrique Soriano Guppy
In Argentina, there was not an adapted and validated instrument to evaluate readiness for the transition to adult health care. The purpose of this study was to describe the process of cross-cultural adaptation of the Transition Readiness Assessment Questionnaire 5.0 to Argentinian Spanish. The authors of the instrument were contacted to this effect. Stage 1: two translators performed the translation to Spanish. Stage 2: based on these two versions, version 1 was agreed upon. Stage 3: two back-translations were performed...
April 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28314461/transition-to-adult-health-care-services-for-young-adults-with-chronic-medical-illness-and-psychiatric-comorbidity
#12
REVIEW
Margaret McManus, Patience White
This article provides national data on the lack of transition preparation among youth with special health care needs, including those with emotional, behavioral, and developmental conditions. Consumer and provider transition barriers pertaining to inadequate transition support are summarized. In addition, current US transition goals are presented along with health professional recommendations on transition. The Six Core Elements of Health Care Transition, which are aligned with professional recommendations, are reviewed with practice-based lessons learned from quality improvement efforts...
April 2017: Child and Adolescent Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28314459/autism-spectrum-disorders-challenges-and-opportunities-for-transition-to-adulthood
#13
REVIEW
Gerrit I van Schalkwyk, Fred R Volkmar
Improved outcomes for individuals with autism spectrum disorder (ASD) have opened a range of potential pathways during the transition to adulthood. These include attending college, entering the labor force, and achieving a degree of independent living. Less cognitively able individuals may be eligible for state benefits and may enter supported employment programs. Those attending college require careful support and planning. Practitioners need to be familiar with the unique needs of young adults with ASD. Further research should attempt to define the priorities of individuals and families with ASD making this transition and clarify the value of existing supports and interventions...
April 2017: Child and Adolescent Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28314457/transitional-age-lesbian-gay-bisexual-transgender-and-questioning-youth-issues-of-diversity-integrated-identities-and-mental-health
#14
REVIEW
Scott M Rodgers
Although most LGBTQ youth become healthy young adults, they often face considerable stress over the course of their lives because of bullying, victimization, and overt/covert discrimination. Families, educational and religious institutions, health care professionals, and communities help shape the experience of LGBTQ transitional age youth. LGBTQ youth have higher rates of depression, suicide, anxiety, posttraumatic stress disorder, alcohol and drug use, and preventable sexually transmitted diseases. When best practice guidelines are followed and key stakeholders take action to support LGBTQ youth, health disparities begin to disappear...
April 2017: Child and Adolescent Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28314449/aligning-mental-health-treatments-with-the-developmental-stage-and-needs-of-late-adolescents-and-young-adults
#15
REVIEW
Brian Skehan, Maryann Davis
Transitional age youth (TAY) are in a discrete developmental stage, different from both adolescents and mature adults. Serious mental illness can result in their delayed psychosocial development and morbidity. Systemic, provider, and individual barriers result in poor access to care for these youth, potentially impeding their transition to mature adulthood. Current strategies for TAY treatment include patient centered care, vocational and educational support, and shared decision making. There is a paucity of evidence-based practices to effectively treat this population or provide practice guidelines...
April 2017: Child and Adolescent Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28292222/the-transition-to-the-adult-health-care-system-among-youths-with-autism-spectrum-disorder
#16
Robert A Nathenson, Benjamin Zablotsky
OBJECTIVE: The study examined how health care utilization patterns among youths with autism spectrum disorder (ASD) change as they transition into the adult health care system. METHODS: Data came from the Clinformatics Data Mart Database, a nationally diverse, clinically rich, private insurance claims database. The analytic sample consisted of youths ages 16 to 23 who were diagnosed as having ASD (N=16,338). Cross-sectional multivariate linear regressions determined whether service usage in home, office or outpatient, inpatient, and emergency department (ED) settings differed by age...
March 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28291562/consequences-of-sarcopenia-among-nursing-home-residents-at%C3%A2-long-term%C3%A2-follow-up
#17
Tim Henwood, Bothaina Hassan, Paul Swinton, Hugh Senior, Justin Keogh
The consequences of and transition into sarcopenia with long-term survival was investigated in the nursing home setting. Eligible residents from 11 nursing homes were followed-up 18-months after their assessment for sarcopenia using the European Working Group on Sarcopenia in Older People criteria, with other demographic, physical and cognitive health measures collected. Of the 102 older adults who consented at baseline, 22 had died and 58 agreed to participate at follow-up, 51.7% of whom had sarcopenic. Sarcopenia at baseline was associated with a depression (p < ...
March 10, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/28291051/30-day-readmission-rates-in-an-hiv-infected-cohort-from-rio-de-janeiro-brazil
#18
Lara E Coelho, Sayonara R Ribeiro, Andre M Japiassu, Ronaldo I Moreira, Priscila C Lara, Valdilea G Veloso, Beatriz Grinsztejn, Paula M Luz
BACKGROUND: The 30-day readmission rate is an indicator of the quality of hospital care and transition to the outpatient setting. Recent studies suggest HIV infection might increase the risk of readmission though estimates of 30-day readmission rates are unavailable among HIV infected individuals living in middle/low income settings. Additionally, factors that may increase readmission risk in HIV infected populations are poorly understood. METHODS: 30-day readmission rates were estimated for HIV-infected adults from the Instituto Nacional de Infectologia Evandro Chagas/Fiocruz cohort in Rio de Janeiro, Brazil, from January 2007 to December 2013...
March 10, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28289431/management-issues-of-congenital-adrenal-hyperplasia-during-the-transition-from-pediatric-to-adult-care
#19
REVIEW
Jin-Ho Choi, Han-Wook Yoo
Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers...
February 2017: Korean Journal of Pediatrics
https://www.readbyqxmd.com/read/28277408/hospital-standards-to-promote-optimal-surgical-care-of-the-older-adult-a-report-from-the-coalition-for-quality-in-geriatric-surgery
#20
Julia R Berian, Ronnie A Rosenthal, Tracey L Baker, JoAnn Coleman, Emily Finlayson, Mark R Katlic, Sandhya A Lagoo-Deenadayalan, Victoria L Tang, Thomas N Robinson, Clifford Y Ko, Marcia M Russell
OBJECTIVE: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult. BACKGROUND: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery. METHODS: Using a modified RAND-UCLA Appropriateness Methodology, 44 of 58 CQGS Stakeholders twice rated validity (primary outcome) and feasibility for 308 standards, ranging from goals and decision-making, pre-operative assessment and optimization, perioperative and postoperative care, to transitions of care beyond the acute care hospital...
March 8, 2017: Annals of Surgery
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