Exploring the need for sexually transmitted infection education among university student athletes in Saskatchewan.

Background: Sexually transmitted infections (STIs) are common in young adults in Canada and their prevalence is rising. Assessing sexual health knowledge among young adults is essential for developing effective STI education strategies. However, there is limited research on the sexual health knowledge of Canadian university athletes, who have increased risks of STIs. Objective: To determine perceived and objective levels of knowledge on STIs among university athletes and their preferred methods of knowledge translation regarding sexual health information. Methods: U SPORTS athletes at the University of Saskatchewan and the University of Regina were invited to complete an electronic survey between January-March 2022. Participants completed the Sexual Transmitted Disease Knowledge Questionnaire (STD-KQ) and self-reported their confidence in their answers. Participants were asked about testing beliefs, where they receive their sexual health information and their preferred format for STI information delivery. Results: One hundred participants completed the survey (14% response rate). Participants had a median composite self-reported STI knowledge score of 2.8 out of 5 (interquartile range [IQR]: 2.4-3.6). The median participant scored 12 out of 27 (44%) on the STD-KQ (IQR: 8-17). Sixty-seven percent of participants received sexual health information from a physician. Sixty-one percent of participants believed embarrassment may prevent them from getting tested or screened. The three most popular methods of health information sharing were online modules (34%), in-person lectures/conferences (24%) and self-paced videos (20%). Conclusion: This study highlighted that STI knowledge is limited in university athletes. Comprehensive online educational interventions may be effective at improving knowledge.

The true complexities of "standard" family practice visits unmasked: an observational cross-sectional study in Regina.

BACKGROUND: Many patients present to their family medicine clinic with more than one health concern, placing an increased demand on family physicians. Research into the average number of concerns per regular family medicine visit is limited. Recognition of the frequency that family physicians address more than one concern per visit and adapting practices accordingly is important for improving patient care. OBJECTIVE: To examine whether family physicians routinely address multiple different patient concerns during a single visit and if this is influenced by patient demographics. METHODS: This study was conducted at a multi-physician family medicine clinic in Regina, Saskatchewan, Canada. Five physicians contributed their 500 most recent charts, extending retrospectively from 1 June 2023, from in-person visits by patients over 18 years of age and billed as regular appointments without billed procedures. Each chart was reviewed for the number of concerns addressed in the visit. RESULTS: Fifty percent of visits addressed more than 1 concern (range = 1-8). A generalized linear mixed model using Poisson distribution showed certain physicians (incident rate ratio [IRR]: 1.192, 95% CI: 1.087-1.307, P < 0.001) and adults older than 65 years compared to adults less than 40 years (IRR 1.151, 95% CI: 1.069-1.239, P < 0.001) were more likely to present with multiple concerns, but patient sex was not a significant predictor. CONCLUSIONS: Family physicians routinely address more than one concern per visit. Standard visit length and billing practices should be adapted to reflect this complexity.

Intimidation or harassment among family medicine residents in Saskatchewan: a cross-sectional survey.

Introduction: Up to 98% of practicing family physicians, and over 75% of resident physicians in Canada experience abusive incidents. Despite the negative consequences of abusive incidents, few residents report these events to their supervisors or institution. We sought to estimate the prevalence of abusive incidents experienced or witnessed by Saskatchewan family medicine residents (FMRs) and identify their responses to these events. Methods: Anonymous survey invitations were emailed to all 110 Saskatchewan FMRs in Saskatchewan in November and December 2020. Demographic characteristics, frequency of witnessed and experienced abusive incidents, sources of incidents and residents' responses were collected. Incidents were classified as minor, major, severe, or as racial discrimination based on a previously published classification system. Results: The response rate was 34.5% (38/110). Ninety-two percent (35/38) of residents witnessed a minor incident and 91.7% (32/36) of residents experienced a minor incident. Seventy-one percent (27/38) of residents witnessed racial discrimination while 19.4% (7/36) of residents experienced racial discrimination. Patients were the most common source of abusive incidents. Twenty-nine percent of residents reported abusive incidents to their supervisors. Most residents were aware of institutional reporting policies. Conclusions: Most Saskatchewan FMRs experienced or witnessed abusive incidents, but few were reported. This study provided the opportunity to reassess policies on abusive incidents, which should consider sources of abuse, confidence in reporting, and education.

Introduction: Jusqu'à 98 % des médecins de famille en exercice et plus de 75 % des médecins résidents au Canada sont victimes d'incidents de violence. Malgré le préjudice subi, peu de résidents signalent ces incidents à leurs superviseurs ou à l'établissement. Nous avons tenté d'estimer la prévalence des incidents de violence dont ont été victimes ou témoins les résidents en médecine familiale (RMF) en Saskatchewan et de connaître leurs réactions face à ces situations. Méthodes: Des invitations à participer à un sondage anonyme ont été envoyées par courriel aux 110 RMF de la Saskatchewan en novembre et décembre 2020. Nous avons recueilli des données portant sur les caractéristiques démographiques des résidents, sur la fréquence des incidents de violence dont ils ont été témoins ou victimes, sur les sources des incidents et sur leurs réactions aux incidents. Ces derniers ont été classés comme mineurs, majeurs, graves ou comme actes de discrimination raciale sur la base d'un système de classification existant. Résultats: Le taux de réponse a été de 34,5 % (38/110). Quatre-vingt-douze pour cent (35/38) des résidents ont été témoins d'un incident mineur et 91,7 % (32/36) en ont vécu un eux-mêmes Soixante et onze pour cent (27/38) des résidents ont été témoins de discrimination raciale, tandis que 19,4 % (7/36) en ont été victimes. Le plus souvent, les auteurs de comportements violents étaient des patients. Vingt-neuf pour cent des résidents ont signalé l'incident à leur superviseur. La plupart des résidents connaissaient la politique de signalement de la violence de l'établissement. Conclusions: La plupart des RMF de la Saskatchewan ont vécu des incidents violents ou en ont été témoins, mais peu d'entre eux les ont signalés. Cette étude ouvre la voie à une réévaluation des politiques en matière de prévention de la violence, qui devraient tenir compte des sources de la violence et de la confiance des victimes envers le processus de signalement, et prévoir de la formation.

Assessment of Knowledge, Comfort, and Skills Working with Transgender Clients of Saskatchewan Family Physicians, Family Medicine Residents, and Nurse Practitioners.

People who are transgender and gender diverse (TGD) report suboptimal care from health care providers. A cross-sectional survey was codesigned with community partners to assess the knowledge, comfort, and skills of family physicians, family medicine residents, and nurse practitioners working with TGD patients in Saskatchewan. It was administered from August to October 2019. Of 188 participants, 30% and 96% were comfortable providing transition-related and non-transition-related medical care to patients who are TGD, respectively. Interest in further training in providing transition-related medical care and cultural safety was high. No significant differences between provider groups were observed. Based on our results, provincial training initiatives will be undertaken.

Differences in goals of care discussion outcomes among healthcare professionals: an observational cross-sectional study.

BACKGROUND: Goals of care discussions ensure patients receive the care that they want. Recent studies have recognized the opportunity for allied health professionals, such as nurses, in facilitating goals of care discussions. However, the outcomes of such interventions are not well studied. AIM: To compare the outcomes of goals of care discussions led by physicians and nurses. DESIGN: This is a retrospective cohort study of patients admitted to an Internal Medicine unit from January 2018 to August 2019. A comprehensive chart review was performed on a random sample of patients. Patient's decision to accept or refuse cardiopulmonary resuscitation was recorded and analyzed. Analysis was stratified by patients' comorbidity burden and illness severity. SETTING/PARTICIPANTS: The study took place at a tertiary care center and included 200 patients. Patients aged ⩾ 18 were included. Patients who have had pre-existing goals of care documentation were excluded. RESULTS: About 52% of the goals of care discussions were completed by nurses and 48% by physicians. Patients were more likely to accept cardiopulmonary resuscitation in nurse-led discussions compared to physician-led ones (80.8% vs 61.4%, p = 0.003). Multiple regression showed that patients with higher comorbidity burden (OR 0.71, 95% CI: 0.62-0.82), more severe illness (OR 0.89, 95% CI 0.88-0.99), and physician-led goals of care discussions (OR 0.30, 95% CI: 0.15-0.62) were less likely to accept cardiopulmonary resuscitation. CONCLUSIONS: There was a significant difference between the outcomes of goals of care discussions led by nurses and physicians. Patients were more likely to accept aggressive resuscitative measures in nurse-led goals of care discussions. Further research efforts are needed to identify the factors contributing to this discrepancy, and to devise ways of improving goals of care discussion delivery.

Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients.

OBJECTIVES: To evaluate the number of out-of-hospital cardiac arrest (OHCA) patients eligible for extracorporeal cardiopulmonary resuscitation (ECPR) in Saskatchewan and their clinical outcomes, including survival and neurological outcomes at discharge. ECPR eligibility was assessed, using clinical criteria from the University of British Columbia (UBC, Canada), University of Michigan (UM, United States), University of California (UC, United States) and a restrictive ECPR criteria. RESULTS: We performed a retrospective cohort study of 200 OHCA patients (August 1, 2017-May 31, 2019) in Regina, Saskatchewan. Sixty-one (30%) were female, the median age was 64 years (interquartile range [IQR], 52-78), the median CPR duration was 30 min (IQR 12-47), and 20% survived to discharge. Two (1%) patients received ECPR but did not meet any ECPR criteria. Nineteen (10%), thirty (15%), twenty-two (11%), and seven (4%) patients were ECPR-eligible, using the UBC, UM, UC, and restrictive criteria. However, none of these patients had received ECPR. Only two (11%), two (7%), two (9%), and one (14%) of these patient(s) survived to discharge, respectively. Neurological outcomes were unfavourable among all ECPR-eligible patients. Future study at our centre will be necessary on how to implement ECPR program to further improve these outcomes.

Interpretation and management of genetic test results by Canadian family physicians: a multiple choice survey of performance.

Family physicians (FPs) will encounter genetic concerns within community practice. To determine how FPs compare to genetic counselors (GCs), a cross-sectional survey was distributed to Canadian FPs and GCs in 2019. The survey assessed risk analysis, counseling, and management of genetic information. FPs performed less well than GCs on each survey question and scenario (p < 0.05). Average overall survey scores for FPs were lower than GCs (62% vs. 93%, p < 0.001). Additional genetic training for FPs may help avoid potential harm.

Long-Term Impact of Bariatric Surgery on Renal Outcomes at a Community-Based Publicly Funded Bariatric Program: The Regina Bariatric Study.

BACKGROUND: Obesity is recognized as an independent risk factor for chronic kidney disease through multiple direct and indirect biological pathways. Bariatric surgery is a proven, effective method for sustained weight loss. However, there is a relative paucity of data on the impact of bariatric surgery on renal outcomes. OBJECTIVE: The primary objective was to evaluate the change in urine albumin/creatinine ratio (ACR) in patients undergoing bariatric surgery, at 12 months after the procedure. Secondary objectives were to determine the changes in ACR at (6 and 24 months), estimated glomerular filtration rate (eGFR; 6, 12, and 24 months), and hemoglobin A1c (HbA1c); 12 and 24 months) after the procedure. DESIGN: This observational retrospective cohort study included consecutive obese patients who underwent bariatric surgery. SETTING: Provincial Bariatric Surgery Clinic at the Regina General Hospital, Saskatchewan. PATIENTS: This study includes 471 consecutive obese adult patients who underwent bariatric surgery between 2008 and 2015. MEASUREMENTS: We studied the impact of bariatric surgery on body mass index (BMI), renal outcomes (urine ACR and eGFR) and metabolic outcomes (fasting glucose, total cholesterol, low-density lipoprotein, triglycerides, and HbA1c) in 471 patients. METHODS: Patients were followed for 2 years postsurgery in the bariatric clinic. Mixed linear models that accounted for the repeated nature of the data were used to access changes in outcomes over time. RESULTS: Patients were predominantly female (81%) with a mean age (±SD) of 46 ± 10 years. Most patients (87%) had a BMI > 40 kg/m2 and 81% of the patients underwent Roux-en-Y gastric bypass. The mean BMI decreased from 47.7 ± 7.8 kg/m2 at baseline to 37.1 ± 7.9 kg/m2 at 6 months and 34.8 ± 8.8 kg/m2 at 12 months. In a subcohort of patients with microalbuminuria, ACR showed an improvement from a median [interquartile] value of 5.1 [3.7-7.5] mg/mmol at baseline to 2.3 [1.2-3.6] mg/mmol at 6 months (P = .007), to 1.4 [0.9-3.7] mg/mmol at 2-year follow-up (P < .001). Similarly, eGFR increased in patients with microalbuminuria from 109 ± 10 mL/min/1.73 m2 at baseline to 120 ± 36 mL/min/1.73 m2 at 2-year follow-up (P = .013). There were statistically significant reductions in triglycerides, fasting glucose, and HbA1c. LIMITATIONS: This was a retrospective chart review, with the lack of a control group. Patients with eGFR less than 60 mL/min/1.73 m2 were not considered for surgery, and we had to measure renal outcomes predominantly on the presence of proteinuria. CONCLUSIONS: Our results suggest bariatric surgery significantly decreased weight and consequently improved renal and metabolic outcomes (eGFR, ACR, fasting glucose, cholesterol, and triglycerides) in patients with elevated BMI.

CONTEXTE: L'obésité est reconnue comme un facteur de risque indépendant d'insuffisance rénale chronique (IRC) via de multiples voies biologiques directes et indirectes. La chirurgie bariatrique est une méthode efficace et éprouvée pour perdre du poids de façon durable. Or, il existe peu de données mesurant l'impact de cette intervention sur les issues rénales. OBJECTIFS: L'objectif principal était de mesurer la variation du rapport albumine/créatinine (RAC) urinaire chez des patients subissant une chirurgie bariatrique, 12 mois après l'intervention. On souhaitait aussi mesurer le RAC (6 mois et 24 mois), le débit de filtration glomérulaire estimé (DFGe) (6, 12 et 24 mois) et le taux d'hémoglobine glyquée (HbA1c) (12 et 24 mois) à intervalles réguliers après l'intervention. TYPE D'ÉTUDE: Étude de cohorte rétrospective observationnelle portant sur des patients obèses ayant subi une chirurgie bariatrique. CADRE: La clinique provinciale de chirurgie bariatrique du Regina General Hospital (Saskatchewan). SUJETS: Un total de 471 patients consécutifs ayant subi une chirurgie bariatrique entre 2008 et 2015. MESURES: Nous avons étudié l'impact de la chirurgie bariatrique sur l'indice de masse corporelle (IMC), les issues rénales (RAC, DFGe) et les résultats métaboliques (glycémie à jeun, cholestérol total) de 471 patients. MÉTHODOLOGIE: Les patients ont été suivis dans une clinique bariatrique jusqu'à deux ans après l'intervention. Des modèles mixtes linéaires tenant compte de la nature répétitive des données ont été employés pour évaluer les variations dans les résultats au fil du temps. RÉSULTATS: La cohorte était majoritairement féminine (81%) et l'âge moyen (±SD) se situait à 46 ± 10 ans. La majorité des sujets (87%) présentait un IMC supérieur à 40 kg/m2 et 81% des patients avaient subi une dérivation gastrique de type Roux-en-Y. L'IMC moyen est passé de 47,7 ± 7,8 kg/m2 (initial) à 37,1 ± 7,9 kg/m2 après 6 mois, et à 34,8 ± 8,8 kg/m2 après 12 mois. Dans une sous-cohorte de patients atteints de microalbuminurie, le RAC est passé d'une valeur médiane (EIQ) initiale de 5,1 [3,7-7,5] mg/mmol à 2,3 [1,2-3,6] mg/mmol après 6 mois (P = 0,007), et à 1,4 [0,9-3,7] mg/mmol après deux ans de suivi (P < 0,001). Parallèlement, dans cette même sous-cohorte, le DFGe est passé de 109 ± 10 mL/min/1,73 m2 (initial) à 120 ± 36 mL/min/1,73 m2 après deux ans de suivi (P = 0,013). Des réductions statistiquement significatives ont également été observées pour les triglycérides, la glycémie à jeun et l'HbA1c. LIMITES: Il s'agit d'une analyze de dossiers rétrospective sans groupe contrôle. Les patients avec un DFGe inférieur à 60 mL/min/1,73 m2 n'ont pas été pris en compte pour l'intervention et nous avons dû mesurer les issues rénales principalement en fonction de la présence d'une protéinurie. CONCLUSION: Nos résultats suggèrent que la chirurgie bariatrique entraîne une perte significative de poids et, conséquemment, une amélioration des issues rénales et métaboliques (DFGe, RAC, glycémie à jeun, taux de cholestérol et de triglycérides) chez les patients présentant un IMC élevé.

Food Service Workers: Reliable Assessors of Food Intake in Hospitalized Patients.

Early detection of malnutrition in hospitalized patients is of paramount importance. As poor food intake is a marker of malnutrition risk, a simple and accurate method to monitor intake is valuable. This quality assurance project aimed to determine if food service workers (FSW) were able to provide accurate estimates of patient intakes through visually assessing meal trays at an acute care hospital. FSW conducted visual estimates of patient trays after meals using the meal plate pictorial rating scale adapted from the My Meal Intake Tool and translated their estimates into one of 5 consumption levels (0%, 25%, 50%, 75%, or 100%). A total of 401 patient meal estimates were validated using the food weighing method. Spearman's correlations between percent calories consumed (determined by weight) and estimates by FSW were 0.624 (n = 137, P < 0.001), 0.771 (n = 134, P < 0.001), and 0.829 (n = 130, P < 0.001), for breakfast, lunch, and supper, respectively. Paired Wilcoxon tests and the Kruskal-Wallis H test showed that accuracy varied for breakfast, lunch, and supper. The overall sensitivity and specificity of FSW for detecting patient intake ≤50% was 81% and 88%, respectively. These findings identify that FSW can accurately estimate patient intake, contributing an important marker for the detection of malnutrition.

Interaction of the P-Glycoprotein Multidrug Transporter with Sterols.

The ABC transporter P-glycoprotein (Pgp, ABCB1) actively exports structurally diverse substrates from within the lipid bilayer, leading to multidrug resistance. Many aspects of Pgp function are altered by the phospholipid environment, but its interactions with sterols remain enigmatic. In this work, the functional interaction between purified Pgp and various sterols was investigated in detergent solution and proteoliposomes. Fluorescence studies showed that dehydroergosterol, cholestatrienol, and NBD-cholesterol interact intimately with Pgp, resulting in both quenching of protein Trp fluorescence and enhancement of sterol fluorescence. Kd values indicated binding affinities in the range of 3-9 µM. Collisional quenching experiments showed that Pgp-bound NBD-cholesterol was protected from the external milieu, resonance energy transfer was observed between Pgp Trp residues and the sterol, and the fluorescence emission of bound sterol was enhanced. These observations suggested an intimate interaction of bound sterols with the transporter at a protected nonpolar site. Cholesterol hemisuccinate altered the thermal unfolding of Pgp and greatly stabilized its basal ATPase activity in both a detergent solution and reconstituted proteoliposomes of certain phospholipids. Other sterols, including dehydroergosterol, did not stabilize the basal ATPase activity of detergent-solubilized Pgp, which suggests that this is not a generalized sterol effect. The phospholipid composition and cholesterol hemisuccinate content of Pgp proteoliposomes altered the basal ATPase and drug transport cycles differently. Sterols may interact with Pgp and modulate its structure and function by occupying part of the drug-binding pocket or by binding to putative consensus cholesterol-binding (CRAC/CARC) motifs located within the transmembrane domains.

Lipid bilayer properties control membrane partitioning, binding, and transport of p-glycoprotein substrates.

The ABC protein P-glycoprotein (Pgp or ABCB1) is a multidrug efflux pump capable of transporting many structurally diverse substrates from within the lipid bilayer. Previous studies have demonstrated the importance of the membrane in modulating Pgp function, but few have quantified these effects. We employed purified Pgp reconstituted into phospholipid bilayers with defined gel to liquid-crystalline melting transitions to investigate the effect of membrane environment on the transporter and three of its substrates. Equilibrium dialysis measurements indicated that Hoechst 33342, LDS-751, and MK-571 partitioned much more readily into liquid-crystalline phase bilayers than into gel phase bilayers. However, drug binding affinities revealed that Pgp bound the three substrates more tightly when the lipid bilayer was in the gel phase. The binding affinity of the transporter for substrates within the bilayer was low, in the millimolar range, suggesting that it interacts with them weakly. Thermodynamic analysis revealed that both drug-Pgp and drug-lipid interactions contribute to binding affinity. The kinetics of LDS-751 and Hoechst 33342 transport by reconstituted Pgp was monitored using a real-time fluorescence-based assay to obtain apparent turnover frequencies. Transport rates were found to be sensitive to both drug structure and lipid environment. Arrhenius and transition state analysis of transport rates suggested that the rate of drug transport depends on both the affinity of Pgp for substrate and protein conformational changes. Transport rates did not appear to be limited exclusively by the rate of ATP hydrolysis and may be partially controlled by the rate of drug dissociation.

The origin of the conductivity maximum in molten salts. I. Bismuth chloride.

A new theory is presented to explain the conductivity maxima of molten salts (versus temperature and pressure). In the new theory, conductivity is due to ions hopping from counterion to counterion, and its temperature dependence can be explained with an ordinary Arrhenius equation in which the frequency prefactor A (for hopping opportunities) and activation energy E(a) (for hopping) are density dependent. The conductivity maximum is due to competing effects: as density decreases, the frequency of opportunities for hopping increases, but the probability that an opportunity is successfully hopped decreases due to rising E(a) caused by the increased hopping distance. The theory is successfully applied to molten bismuth (III) chloride, and supported by density-functional based molecular dynamics simulations which not only reproduce the conductivity maximum, but disprove the long-standing conjecture that this liquid features an equilibrium between BiCl(3) molecules, and BiCl(2)(+) and BiCl(4)(-) ions that shifts to the left with increasing temperature.