Advertisement

Advertisement

JCCC 2016 Issue 2

Table of Contents

Navigating the Gender Spectrum: A General Overview of Transgender Health Care

Navigating the Gender Spectrum: A General Overview of Transgender Health Care

Teaser: 

Dr. Adam C. Millar, MD, MScCH, FRCPC,

Mount Sinai Hospital, Assistant Professor, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract:Transgenderism is common, with quoted prevalence rates of between 0.5-1% of the population.1,2,3 The term "transgender" reflects a broad spectrum of identities, including agender, pangender, genderqueer and genderfluid. Although there is increased public recognition of transgender issues, many physicians remain uncomfortable managing matters of transgender health. There is a paucity of high quality, long term randomized controlled trials on many transgender health topics, requiring physicians to rely largely on consensus guidelines. Integration of transgender-related subject matter into medical school curricula is one of the first steps towards enabling future physicians to increase their comfort in transgender health care.
Key Words: Transgender, trans, testosterone, estrogen, androgen blockade.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Transgenderism is not limited to the binary gender constructs of male and female. The term "transgender" includes a broad spectrum of identities, including agender, pangender, genderfluid and genderqueer.
2. Lack of physician comfort with medical management of the transgender patient has been linked to increased rates of refusal of medical care, as well as verbal harassment and in extreme cases physical assault.
3. Due in part to a lack of large randomized controlled trials, many transgender guideline recommendations are based on expert opinion and relatively low quality evidence.
Rather than assume one's gender identity, it is advisable to ask the patient how they identify, and what pronouns are preferred.
There are no specific hormonal targets during transition therapy. Instead, treatment targets are defined by the patient's goals and overall sense of well-being.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Gender & Health, Men’s Health, Urogenital Disorders, Women’s Health, Transgender, trans, testosterone, estrogen, androgen blockade

Benign Prostatic Hyperplasia—Medical and Surgical Treatment Options

Benign Prostatic Hyperplasia—Medical and Surgical Treatment Options

Teaser: 

Dean S. Elterman, MD, MSc, FRCSC,1 Udi Blankstein, MD,2

1Attending Urologic Surgeon, Toronto Western Hospital, University Health Network, Assistant Professor, Division of Urology, Department of Surgery, University of Toronto, Toronto, ON.
2Department of Urology, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: Benign prostatic hyperplasia (BPH) affects the aging male. Treatment options vary widely. Some men will elect to conservatively monitor their symptoms and make alterations to their lifestyle choices. Pharmacotherapy options exist as well, and include alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors. Lastly, surgical options are also a viable treatment option, with many types at the disposal of the caregiver. Technological advancements have changed, and will continue to change the field in the near future. This review outlines the important aspects of this common affliction.
Key Words:Benign prostatic hyperplasia, management, treatment, referral.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
There is a spectrum of bother ranging from mild nuisance to significant decrease in quality of life – this is largely associated with how the patient perceives the problem.
Physical exam and medical history are imperative in the initial assessment of BPH.
Conservative measures and lifestyle changes should be the first line treatment choice.
Surgical intervention should be attempted after failure of medical therapy to alleviate symptoms and prevent kidney injury or infection.
Ensure that there are no other causes that may cause LUTS such as various medications, and other comorbidities.
When considering more invasive intervention, ensure that the surgical team knows the patient's anticoagulation status.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Gender & Health, Men’s Health, benign prostatic hyperplasia, management, treatment, referral

Cutaneous Features of Neurofibromatosis

Cutaneous Features of Neurofibromatosis

Teaser: 

Sang-Eun Kim , BSc, MSc,1 Joseph M. Lam, MD, FRCPC,2

1Faulty of Medicine, University of British Columbia, BC.
2Assistant Clinical Professor, Department of Paediatrics, Associate Member, Department of Dermatology, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder that is characterized by café-au-lait spots, axillary or inguinal freckles, cutaneous neurofibromas, and skeletal dysplasias. Currently, there are no curative therapies for NF1 but medical therapies, including systemic sirolimus, have opened the door for significant medical advances in the treatment of NF1. Management of NF1 has been focused on routine examinations looking out for potential complications of NF1. However, many patients with NF1 are missed and may not be diagnosed early. The following review article will provide an overview of select common and uncommon cutaneous features of NF1 to help the practitioner recognize, diagnose and treat patients with NF1.
Key Words: Neurofibromatosis type 1, café-au-lait spots, axillary freckles, inguinal freckles, cutaneous neurofibromas.
Clinical diagnosis of NF1 requires the presence of at least 2 out of the 7 criteria.
Not all patients with café-au-lait spots will have NF1.
Axillary and inguinal freckling are the most specific criteria for NF1.
Three different types of cutaneous neurofibromas are dermal, subcutaneous, and plexiform neurofibromas (PNs). PNs can become malignant.
Juvenile xanthogranuloma and nevus anemicus are uncommon associated cutaneous features of NF1.
NF1 is a genetic disorder and there is no cure.
Patients should be routinely monitored for rare complications and annual exam should include BP measurement, skin and bone abnormality assessment, visual acuity checks, and ophthalmological evaluations.
Not all Cafe-au-lait spots require specialist referral however early recognition and prompt referral is essential.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Dermatology, Neurofibromatosis type 1, café-au-lait spots, axillary freckles, inguinal freckles, cutaneous neurofibromas