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Context Breastfeeding is known to have many health and wellness benefits to the mother and infant; however, breastfeeding in trans women has been greatly under-researched. Objective To review potential methods of lactation induction in trans women wishing to breastfeed and to review the embryological basis for breastfeeding in trans women. Design This article summarizes a case of successful lactation in a trans woman, in which milk production was achieved in just over 1 month. Setting This patient was followed in an outpatient endocrinology clinic. Participant A single trans woman was followed in our endocrinology clinic for a period of 9 months while she took hormone therapy to help with lactation. Interventions Readily available lactation induction protocols for nonpuerpural mothers were reviewed and used to guide hormone therapy selection. Daily dose of progesterone was increased from 100 mg to 200 mg daily. The galactogogue domperidone was started at 10 mg 3 times daily and titrated up to effect. She was encouraged to use an electric pump and to increase her frequency of pumping. Main Outcome Measure Lactation induction Results At one month, she had noticed a significant increase in her breast size and fullness. Her milk supply had increased rapidly, and she was producing up to 3 to 5 ounces of milk per day with manual expression alone. Conclusions We report the second case in the medical literature to demonstrate successful breastfeeding in a trans woman through use of hormonal augmentation.

We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = -0.09 to 0.91).

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Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and resource utilization associated with this condition, research has recently focused on ways of preventing its prevention this condition; primarily using colchicine, NSAIDs and corticosteroids. Areas covered: This systematic review summarizes the three clinical studies that have used corticosteroids for PPS primary prevention in the perioperative period. Due to the heterogeneity amongst these three studies in terms of population (both pediatric and adult patients), surgical procedure, administration regimen and results (only 1/3 studies reporting a positive effect), the effectiveness of corticosteroids remains unproven. Expert commentary: Corticosteroids have shown to be useful in the treatment of PPS but have thus far have shown mixed results as a primary prevention method. Research on patients taking corticosteroids pre-operatively have shown a significant reduction in the risk of developing PPS. Further research is required to determine if corticosteroids are helpful in preventing PPS in patient undergoing cardiac surgery, before any recommendations regarding their use in cardiovascular surgery can be made.