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 The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes.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.     

A Hermeneutic Phenomenological Study of the Lived Experience of Spiritual Conversion in a Neo-Charismatic Evangelical Context

Journal of Religion and Health - Hermeneutic phenomenology was used to illuminate the lived experience of posttraumatic, born-again conversion among members of a Neo-Charismatic Evangelical church...     

Assessing visual STM in infants and adults: eye movements and pupil dynamics reflect memory maintenance

Though previous work has demonstrated substantial short-term memory (STM) development in the first year of life (e.g., Ross-Sheehy, S., Oakes, L. M., & Luck, S. J. 2003. The development of visual short-term memory capacity in Infants. Child Development, 74(6), 1807–1822. doi:10.1046/j.1467-8624.2003.00639.x), limitations in infant-based procedures make it difficult to assess the continuity of STM mechanisms from infancy though adulthood. The goal of the current work is to present data collected from both infants and adults using a novel STM assessment task. Eye-tracking was used to capture gaze and pupillometry in 5-, 8- and 11-month-old infants and adults (n?=?176). Infant data replicate and extend previous findings demonstrating clear evidence of STM improvement from 5- to 11-months-of-age. Analysis of adult data reveal qualitatively similar patterns of responding, and additionally reveal several behavioural markers of STM accuracy including pupil dilation, saccade count, and switching. These results suggest that change-detection tasks recruit similar memory mechanisms in both infants and adults, and further suggest that visual dynamics may provide important new continuous measures of STM from infancy through adulthood.     

Frequency of Nonsuicidal Self‐Injury in Adolescents: Differences in Suicide Attempts,Substance Use,and Disordered Eating

The relationship between frequency of nonsuicidal selfinjury (NSSI) and suicide attempts, substance use, and disordered eating was assessed in a community sample of 4,839 adolescents, 922 of whom reported NSSI in the past year. It was expected that the engagement in risk behaviors would significantly increase as NSSI frequency increased. Participants completed the Youth Risk Behavior Survey (Centers for Disease Control and Prevention, 2009) and were subdivided into five NSSI frequency groups: none, 1 time, 2–3 times, 4–5 times, and 6 or more times. A one‐way MANOVA found significant mean differences for all variables across NSSI frequency groups. The no NSSI group was significantly lower than all other groups on all variables. For suicide attempts, all frequency groups were significantly different from each other, with attempt frequency increasing with each increase in NSSI frequency. The six or more group reported significantly more substance use and disordered eating than all other groups. Overall, adolescents with more frequent NSSI represent a group at risk for concurrent unhealthy behaviors and suicide attempts.     

The Validity of a Brief Risk Assessment Tool for Predicting Suicidal Behavior in Veterans Utilizing VHA Mental Health Care

Suicide risk among military veterans is an important and ongoing concern. The Veterans Administration (VA) mandates suicide risk screening of all veterans seen for mental health issues, but little is known about the effectiveness of this screening. A retrospective chart review to examine all suicide risk screens at VA San Diego between October and December 2012 (n = 3,365) was conducted to assess whether results were associated with suicidal behavior over the subsequent 12 months. Patients judged to be at increased risk for suicide were 3 to 16 times more likely to attempt suicide and 7 to 25 times more likely to engage in self‐directed violence over the next 12 months compared with others. The screening tool may be a useful addition to clinical practice.