3707. Urinary Incontinence in Women.
Urinary incontinence (UI) is common among women and contributes to decreased quality of life. Several effective treatment options are available for the most common types of UI (stress, urge, and mixed), including lifestyle and behavioral therapy, drug therapy, and minimally invasive procedures. Most women improve with treatment, and UI is not an inevitable part of aging. To maximize the opportunity for successful treatment, it is critical to align the treatment approach with patient goals and expectations for care, including an assessment of patient-driven priorities regarding potential adverse effects, costs, and expected benefit of different treatment approaches.
3708. Caring for the Transgender Patient: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
作者: Howard Libman.;Joshua D Safer.;Jennifer R Siegel.;Eileen E Reynolds.
来源: Ann Intern Med. 2020年172卷3期202-209页
The term transgender refers to persons whose gender identity is different from that recorded at birth. Similar to other marginalized populations, transgender patients commonly experience discrimination in the health care setting, and they may not have access to medical professionals who can provide competent care. In addition to primary medical and preventive health care, transgender patients need access to gender-affirming interventions, including hormone therapy and surgeries. In 2017, the Endocrine Society updated its clinical practice guideline for the care of transgender persons on the basis of the best available evidence from systematic reviews and individual studies. Among its general requirements for adolescents and recommendations for adults were the following: Involvement of a mental health professional who is knowledgeable about the diagnostic criteria for gender dysphoria and criteria for gender-affirming treatment, has training and experience in assessing psychopathology, and is willing to participate in ongoing care. Hormone therapy should be offered to transgender adult patients, with levels maintained within the normal range for gender identity and treatment appropriately monitored. Clinicians involved in the care of transgender adult patients should be knowledgeable about diagnostic criteria for gender dysphoria/gender incongruence, the use of medical and surgical gender-affirming interventions, and appropriate monitoring for reproductive organ cancer risk. Here, 2 clinicians with expertise in this area debate whether psychological evaluation is warranted in a transgender patient requesting gender-affirming hormones or surgery, the potential risks and benefits of estrogen therapy, and the role of the primary care practitioner in the care of transgender persons.
3719. Sitters as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic Review.
作者: Adela M Greeley.;Elizabeth P Tanner.;Selene Mak.;Meron M Begashaw.;Isomi M Miake-Lye.;Paul G Shekelle.
来源: Ann Intern Med. 2020年172卷5期317-324页
Bedside "sitters" are often used for patients at high risk for falls, but they are expensive and their effectiveness is unclear.
3720. Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016.
作者: Ishani Ganguli.;Zhuo Shi.;E John Orav.;Aarti Rao.;Kristin N Ray.;Ateev Mehrotra.
来源: Ann Intern Med. 2020年172卷4期240-247页
Primary care is known to improve outcomes and lower health care costs, prompting recent U.S. policy efforts to expand its role. Nonetheless, there is early evidence of a decline in per capita primary care visit rates, and little is understood about what is contributing to the decline.
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