ObjectiveFertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for—and qualities of—fertility counselling for TGD adolescents based on clinicians’ experiences.DesignWe conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person’s experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis.SettingThis qualitative study examined experiences of clinicians at the Royal Children’s Hospital—a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia.ParticipantsWe interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents.ResultsBased on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice.ConclusionsIdentification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents’ experiences of fertility counselling are also required.
The aim of this study is to compare previously published height estimation formulae in a contemporary Australian population using vertebral measurements readily available on abdominal CT. Retrospective analysis of patients undergoing a planning CT prior to transcatheter aortic valve implantation in a 12-month period was conducted; 96 participants were included in the analysis from a total of 137, with 41 excluded due to incomplete data. Seven vertebral measurements were taken from the CT images and height estimates were made for each participant using multiple regression equations from the published literature. Paired sample t-tests were used to compare actual height to estimated height. Many of the models failed to accurately predict patient height in this cohort, with only three equations for each sex resulting in a predicted height that was not statistically significantly different to actual height. The most accurate model in female participants was based on posterior sacral length and resulted in a mean difference between an actual and calculated height of 0.7 cm (±7.4) (p = 0.520). The most accurate model in male participants was based on anterior sacrococcygeal length and resulted in a mean difference of −0.6 ± 6.9 cm (p = 0.544). Height estimation formulae can be used to predict patient height from common vertebral parameters on readily available CT data. This is important for the calculation of anthropometric measures for a variety of uses in clinical medicine. However, more work is needed to generate accurate prediction models for specific populations.
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