Experiences of surgery readiness assessments in British Columbia

Abstract

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard.

Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate.

Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia.

Results: We developed three main themes to capture participants’ narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps.

Discussion: These narratives demonstrate how much variation exists among people’s experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.     

Children's kinematic false memories

ABSTRACT

Individuals misrecognise as seen the never-presented natural continuation of an action. These false memories derive from the running of kinematic mental models of the actions seen, which rest on motor inferences from implicit knowledge. We verified an implied prediction: kinematic false memories should be detectable even in children. The participants in our experiments first observed photos in which actors were about to perform actions on objects. At recognition they were presented with the original photos, plus (a) distractors representing the unseen natural continuation of the original actions, (b) distractors representing the beginning of other actions on the same objects and (c) distractors representing completed different actions on the same objects. In contrast to the original studies in which participants expressed their confidence in recognition, in our experiments the participants catgorirzed the action as seen or not seen. After replicating the original results with the dichotomous recognition task (Experiment 1), we detected spontaneous false memories also in children (Experiment 2).     

Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Returning Iraq and Afghanistan War Veterans: Implications for Assessment and Diagnosis

Mild traumatic brain injury (MTBI) and posttraumatic stress disorder (PTSD) are considered the “signature injuries” of combat soldiers returning from Iraq and Afghanistan. Both disorders can greatly affect the functioning of soldiers, yet the disorders often go undetected or are misdiagnosed by both military and civilian health care providers. This article provides information about MTBI and PTSD in returning combat soldiers along with implications for assessment and diagnosis.     

Attentional capture is contingent on scene region: Using surface guidance framework to explore attentional mechanisms during search

Psychonomic Bulletin & Review - Studies have established that scene context guides attention during visual search, but it is not yet clear how. In this study, we examined how attention is...     

Tailored interventions for motivating smoking cessation: using placebo tailoring to examine the influence of expectancies and personalization.

The present study examined mechanisms underlying the effectiveness of tailored interventions for motivating smoking cessation. The study used a placebo-tailoring design to test whether the efficacy of tailoring was due, in part, to personalized features in addition to the theoretically based content. Two hundred forty adult smokers were randomized to 1 of 3 conditions: standard booklet, minimally personalized booklet, or extensively personalized booklet. The interventions varied in their degree of ostensible tailoring, yet the actual smoking-related content of the booklets was identical. A dose-response relationship was hypothesized, with the greatest apparent tailoring producing the most positive outcomes. This pattern was found for evaluation of the booklets, with trends for readiness to change and self-efficacy increases. Moreover, as hypothesized, the effect of the interventions on readiness was moderated by participants' expectancies about tailoring.     

Is Veteran Status and Suicide Risk Assessed in Community Long‐Term Care? A Review of the States' Assessment Instruments

Given recent policy initiatives to address suicide risk among older persons and veterans, community‐based elder serving agencies may serve an important role in identifying and referring individuals at risk for suicide. A review of state‐level long‐term assessment instruments was conducted to determine whether veteran status and suicide are assessed. Data from forty‐three state's Units on Aging instruments were content analyzed. Results indicate that over two thirds of the states in this review included questions about suicide and veterans in their assessments, 69.8% and 67.4% respectively. Suicide risk among elders and veterans must be addressed at local, state, and federal levels so that concerted attention and oversight can be provided for matching elders to the services they need.