Trans-specific Geriatric Health Assessment (TGHA): An inclusive clinical guideline for the geriatric transgender patient in a primary care setting.

There is a growing concern in the field of geriatric medicine that transgender health is often overlooked and under-reported. Not only does this impact the health and safety of the aging transgender community, but it also often influences the ability of physicians to provide high-quality evidence-based care. This article reviews the current knowledge base for geriatric transgender health and aims to organize evidence-based clinical recommendations for the primary care provider. Our proposed guideline, the Trans-specific Geriatric Health Assessment (TGHA), highlights areas of current clinical practice that do not address the geriatric transgender experience and modifies them to include trans-specific clinical recommendations found in the literature. The TGHA emphasizes topics such as cognitive function, vision and hearing, gait and stability, nutrition, sleep, functional/social status, urogenital health, psychiatric health, hormone replacement therapy, cancer screening, disease prevention and advanced care planning. Our review also addresses the limitations of certain clinical topics and where there is significant need for supportive research.

Da Vinci robotic-assisted radical hysterectomy procedural guide.

The Da Vinci robotic surgical platform has rapidly been adopted by skilled surgeons for procedures in gynecologic oncology. The lack of specific procedural guides and surgical atlases for robotic surgery in gynecologic oncology produces challenges in the education of trainees in their role both as the assistant and as the console surgeon. This procedural guide was developed in order to facilitate trainee education in the technical aspects of radical hysterectomy for cervical cancer using the Da Vinci robotic surgical platform. Patient selection, preparation, and the technical aspects of robotic radical hysterectomy are described from both the standpoint of the console surgeon and the bedside assistant.

Predictors of outcomes for women with cervical carcinoma.

BACKGROUND: To determine the impact of race and other factors on the management and outcomes of women treated for cervical cancer in a rural state. METHODS: Following IRB approval, a retrospective review identified 434 eligible women treated for cervical cancer from 1994 to 2000. Collected data included: demographics, clinicopathologic data, primary and adjuvant therapy, recurrence, and survival. Statistical analyses were performed with the Chi-square test, Kaplan-Meier method, and Cox regression. RESULTS: 304 (70%) of the women were white and 130 (30%) were non-white. Non-whites were more likely to present with advanced stage disease [Stage IIB-IVB] (25% vs. 13%; P < 0.01). Whites were more likely to smoke, be married, be employed, and have private insurance. Non-whites were more likely to have medical co-morbidities such as diabetes and hypertension. Although whites with early stage disease were more likely to undergo surgery as their primary therapy than non-whites (93% vs. 84%; P < 0.01), survival was similar. Survival outcomes for advanced stage disease were similar between groups. CONCLUSIONS: Non-whites diagnosed with cervical cancer are more likely to present with advanced stage disease than whites; however, overall survival was similar between groups. Non-whites with early stage disease were more likely to receive primary radiation therapy than whites. The decision to use radiation therapy vs. surgery does not appear to have a detrimental effect on overall survival, but may impact quality of life.