Search Results for: Transgender – Competenze e ruoli del medico di medicina generale

Superato massimale 1000 bimbi per medico in alcune aree del nord

This cohort study examines breast cancer outcomes in transgender and gender-diverse patients compared with cisgender patients, including overall survival and sociodemographic characteristics.

A compelling aspect of both medicine and poetry is how each incites us to articulate our perceptions through specific applications of expressive language. In medicine, words are firmly grounded upon what we directly observe; assumptions are discouraged, for concern that unconscious biases might lead to erroneous conclusions. In poetry, on the other hand, what we see is often just a touchstone for what we can infer, our imaginations unbounded by an idiom that senses as much as it describes. These two modes of comprehending are instructively contrasted in “The Morning After the Election.” We are at first dropped into a narrative about a father and a daughter, reckoning momentarily that the daughter “who had once been his son” and now living far away has been rejected by her family—until the poetically appreciated detail of “the mustache obscuring his lip quivered” as he describes her new imperilment leads us to a deeper inference instead that he must accept and love her. Additional surprising implications that further test objectivity follow, from the reference to another “perfect” son whose death during childbirth ended the patient’s marriage, which underscores how the speaker may have wrongly construed that the transgender child caused familial strife, to the oversimplified and also partly true (yet in retrospect not entirely so, and thus all the more poignant) reason for the patient’s clinic visit as solely “because his blood pressure is high.” Poetry, by transcending the ostensible and harkening to the intuited, allows us to more fully grasp the complexities of our patients’ experiences.

Introduction
Breast cancer survival rates in low-income and middle-income countries significantly differ from those in high-income countries, indicating limited access to first-line systemic therapy for advanced and metastatic tumours. Recent studies have demonstrated the benefits of combining cyclin-dependent kinase 4 and 6 inhibitors (CDK 4/6) with endocrine therapy in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced or metastatic breast cancer. However, in Brazil, the population faces limited access to these drugs, particularly in the public healthcare system.

Methods and analysis
This prospective observational study will enrol 300 female patients from 20 cancer centres across Brazil, divided into two groups based on healthcare coverage: those treated in the public healthcare system (group 1) and those treated in the private healthcare system (group 2). The use or non-use of CDK 4/6 inhibitors is not dictated by the study protocol but rather reflects real-world treatment decisions made by attending physicians. Patients will be followed for 24 months, stratified according to CDK 4/6 inhibitor usage. The project aims to assess health inequities by evaluating the prognosis of patients treated in the public versus private healthcare systems. Outcomes include progression-free survival (PFS), overall survival (OS), quality of life and cost-effectiveness. Kaplan-Meier curves will be used to analyse PFS and OS, while the Cox proportional hazards frailty model will be employed to compare outcomes between healthcare systems, adjusting for prognostic variables.

Ethics and dissemination
The study protocol was approved by the Ethics Committee of the HCor Research Institute (Hospital do Coracão/Associacão Beneficente Síria), which served as the central ethics board for the trial (study number: CAAE 42538621.5.1001.0060; approval letter number: 4.571.507; date: 3 March 2021). All participating centres also obtained approval from their respective local ethics committees prior to patient enrolment: Ethics Committee of Hospital de Câncer de Barretos—Fundacão Pio XII; Ethics Committee of Universidade Estadual de Campinas—UNICAMP; Ethics Committee of Faculdade de Minas Muriaé—FAMINAS; Ethics Committee of Hospital Santa Paula—SP; Ethics Committee of Hospital Alemão Oswaldo Cruz—SP; Ethics Committee of Hospital Regional do Câncer de Presidente Prudente—HRCPP; Ethics Committee of Instituto Brasileiro de Controle do Câncer—IBCC/Oncologia Clínica—SP; Ethics Committee of Instituto de Medicina Integral Prof. Fernando Figueira—IMIP/PE; Ethics Committee of Hospital São Rafael; Ethics Committee of Universidade Federal de São Paulo—UNIFESP; Ethics Committee of Hospital Geral de Fortaleza—HGF; Ethics Committee of Casa de Saúde Santa Marcelina; Ethics Committee of Centro Universitário FMABC; Ethics Committee of Liga Norte Riograndense Contra o Câncer; Ethics Committee of Hospital Mãe de Deus/Associacão Educadora São Carlos—AESC; and Ethics Committee of Instituto do Câncer Brasil—ICB. All patients will provide written informed consent. Study findings will be disseminated through scientific publications and presented to a broad range of stakeholders, including patients, physicians, the general public and policymakers.

Trial registration number
ClinicalTrials.gov identifier: NCT05559528—BRaziLian outcomE for metAStatic breasT cancer (BREAST).

Già Ds ad interim, è medico e scienziato di fama internazionale

La raccolta dei dati sanitari non è più solo ricavata da un esame o dal risultato di un’analisi. Ora arriva direttamente dall’interno del nostro corpo e promette una rivoluzione per…

Focus su medicina di precisione con genomica e IA

Migliore (Fiaso), rivedere la legge spingendo sulle competenze

Mesoterapia – Come funziona la mesoterapia in medicina estetica? Per cosa viene utilizzata, come si svolge il trattamento, quali sono le controindicazioni.

Via a campagna contro i falsi miti su patologia autoimmune

Dal primo luglio succede a Marco Elefanti

Acido ialuronico – Tutto quello che devi sapere sul filler con acido ialuronico: in quali zone si può fare, durata, effetti collaterali e raccomandazioni del medico estetico.

Studio firmato da due docenti di Unibz con un collega di Colonia

Studio della Società italiana di medicina Interna

This Viewpoint discusses the ways in which clinicians can support transgender patients in the face of a growing number of antitransgender policies in the US.