Learning by chance: Investigating gaps in transgender care education amongst family medicine, endocrinology, psychiatry and urology residents.

BACKGROUND: The transgender (trans) population is one of the most underserved in health care. Not only do they face discrimination and stigma from society as a whole, they also have difficulty accessing transition-related care, leading to adverse outcomes such as suicide. We aimed to increase understanding on how our current postgraduate education system contributes to a lack of care for trans patients. METHODS: Our study consisted of 11 semi-structured interviews conducted in 2016 with residents in the following specialties: family medicine (3), endocrinology (3), psychiatry (3), and urology (2). We used Framework Analysis to qualitatively analyze our data. RESULTS: Residents described a lack of trans care education in the core curriculum, in part due to a lack of exposure to experts in this area. They also expressed discomfort when dealing with trans patients, due to inexperience and lack of knowledge. Furthermore, residents in each specialty had false assumptions that other specialties had sufficient knowledge and expertise in trans care. DISCUSSION: This study highlights how the lack of teaching and clinical experiences with trans patients during residency contributes to the poor access to healthcare. By systematically embedding trans care in the curriculum, medical education can play a prominent role in addressing the healthcare disparities of this underserved population.

CONTEXTE: La population transgenre (trans) est l'une des plus mal desservies en matière de soins de santé. Non seulement les transgenres font-ils face à de la discrimination et stigmatisation provenant de la société en général, mais ils ont aussi de la difficulté à accéder aux soins liés à leur transition, ce qui mène souvent à des résultats particulièrement néfastes tel le suicide. Notre but était de mieux comprendre comment le système d'enseignement postgradué actuel contribue au manque de soins pour les patients trans. MÉTHODES: Notre recherche consistait en onze entrevues semi-structurées effectuées en 2016 auprès de résidents des spécialités suivantes : médecine familiale (3), endocrinologie (3), psychiatrie (3) et urologie (2). Nous avons utilisé une méthode ¼Framework Analysis ¼ pour analyser qualitativement nos données. RÉSULTATS: Les résidents ont décrit un manque de formation en soins pour les transgenres dans le cursus de base; celui-ci étant causé en partie par un manque d'exposition aux experts dans ce domaine. Ils ont aussi exprimé un inconfort au moment de prendre en charge les patients trans qu'ils ont expliqué par leur inexpérience et manque de connaissances. De plus, les résidents de chaque spécialité entretenaient la fausse idée que les autres spécialités possédaient la connaissance et l'expertise nécessaires en soins trans. DISCUSSION: Cette étude met en lumière comment le manque d'enseignement et d'expérience clinique auprès des patients trans durant la résidence contribue à l'accès très limité de ces derniers aux soins de santé. En intégrant systématiquement les soins trans dans le cursus, la formation médicale peut jouer un rôle majeur lorsqu'il s'agit de combler les disparités en soins de santé de cette population mal desservie.

Nephrotic syndrome in infants and children: pathophysiology and management.

Nephrotic syndrome is defined by nephrotic-range proteinuria (≥40 mg/m2/hour or urine protein/creatinine ratio ≥200 mg/mL or 3+ protein on urine dipstick), hypoalbuminaemia (<25 g/L) and oedema. This review focuses on the classification, epidemiology, pathophysiology, management strategies and prognosis of idiopathic nephrotic syndrome of childhood, and includes a brief overview of the congenital forms.

Hypertension in pediatric patients with chronic kidney disease: management challenges.

In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem.

Measuring hemoglobin prior to early discharge without routine surveillance ultrasound after percutaneous native renal biopsy in children.

BACKGROUND: We aimed to evaluate the role of post-procedural hemoglobin (hb), without pre-discharge ultrasound (US), after US-guided renal biopsy in children. METHODS: A retrospective review was conducted of consecutive outpatient native kidney biopsies over an 8-year period. Procedures were performed under real-time US guidance. Data collected included number of passes, presence and size of perinephric hematoma, age, body mass index (BMI), blood pressure (BP), fasting status, hb and platelets. Continuous variables were expressed as mean ± standard deviation, group differences were tested with Student's unpaired t test and analysis of variance and correlations were assessed using Pearson's r. Significance was defined as p < 0.05. Hb changes (g/L), percentage hb (%hb) change, hematoma size and positive and negative predictive values (PPV, NPV, respectively) were analyzed. RESULTS: A total of 330 procedures in 300 children (141 females, mean age 11.2 ± 4.30 years) were analyzed. Post-procedural hematoma occurred in 63%. There was a significant (p = 0.0001) post-procedural hb decrease of 6.3 ± 5.5 g/L and %hb decrease of 4.56 ± 4.01%. Fasting during pre-procedural hb estimation and procedural hematoma was associated with a greater hb drop. A ≥10% hb drop had 73% PPV for repeat blood work and US and a 17% PPV for admission, whereas a <10% hb drop had a NPV of 84% and 98%, respectively. Hb change showed a weak correlation with age, and hematoma size showed a weak inverse correlation with platelet count, but no correlation with BMI, number of passes or BP. CONCLUSIONS: Bleeding complications from US-guided native kidney biopsies in pediatric outpatients can be safely followed by a complete blood count at 6 h post procedure. A 10% hb decrease is strongly associated with requirement for further testing and/or admission.