Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership

Background. The past two decades have seen a significant increase in consequences associated with nonmedical misuse of prescription opioids, such as addiction and unintentional overdose deaths. This study aimed to use an electronic survey to assess attitudes and opioid-prescribing practices of Canadian orthopaedic surgeons and trainees following open reduction internal fixation (ORIF) of distal radius and ankle fractures. This study was the first to assess these factors following ORIF of distal radius and ankle fractures using a survey design. Methods. A 40-item survey was developed focusing on four themes: respondent demographics, opioid-prescribing practice, patients with substance use disorders, and drug diversion. The survey was distributed among members of the Canadian Orthopaedic Association. Descriptive statistics were used to summarize respondent demographics and outcomes of interest. A Chi-square test was used to determine if proportion of opioid prescriptions between attending surgeons and surgeons in training was equal. Results. 191 surveys were completed. Most respondents prescribed 10–40 tabs of immediate-release opioids, though this number varied considerably. While most respondents believed patients consumed only 40–80% of the prescribed opioids (73.6%), only 28.7% of respondents counselled patients on safe storage/disposal of leftover opioids. 30.5% of respondents felt confident in their knowledge of opioid use and mechanisms of addiction. Most respondents desired further education on topics such as procedure-based opioid-prescribing protocols (74.2%), alternative pain management strategies (69.7%), and mechanisms of opioid addiction (49.0%). Conclusions. The principle finding of this study is the lack of a standardized approach to postoperative prescribing in distal radius and ankle fractures, illustrated by the wide range in number of opioids prescribed by Canadian orthopaedic surgeons. Our data suggest a trend towards overprescription among respondents following distal radius and ankle ORIF. Future studies should aim to rationalize interventions targeted at reducing postoperative opioid prescribing for common orthopaedic trauma procedures

High rates of posttraumatic stress symptoms in women living with HIV in Canada

Women living with HIV experience high levels of trauma exposure before and after diagnosis. One of the most challenging outcomes following trauma exposure is posttraumatic stress disorder. Despite high exposure to traumatic events, the presence and contributors to posttraumatic stress disorder symptoms have not been examined in women living with HIV in Canada.CHIWOS is funded by a Canadian Institutes of Health Research (CIHR) Operating Grant (grant #MOP-111041), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network (OHTN), and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. The following authors received salary support awards: CIHR Postdoctoral Fellowship (Anne C. Wagner), Clinician Investigator Program at UBC (Denise Jaworsky), Canada Research Chair program (Angela Kaida), Fonds de Recherche Sante QueÂbec and Federation des Omnipracticiens du QueÂbec (Alexandra de Pokomondy). Neora Pick is on the boards of VIIV Healthcare and Gilead Sciences. Alexandra de Pokomandy is a site principal investigator for several VIIV Healthcare HIV trials, is a site co-investigator for Gilead Sciences and Merck HIV trials, and received honoraria for participating on the advisory board for VIIV Healthcare. Mona Loutfy has been a site principal investigator and sub-investigator on Merck, VIIV Healthcare, and Gilead Sciences clinical trials and has been on Advisory Boards for these three pharmaceutical companies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Dissemination of the Women-Centred HIV Care Model: A Multimodal Process and Evaluation

Background Using data from a national cohort study and focus groups, the Women-Centred HIV Care (WCHC) Model was developed to inform care delivery for women living with HIV. Methods Through an evidence-based, integrated knowledge translation approach, we developed 2 toolkits based on the WCHC Model for service providers and women living with HIV in English and French (Canada's national languages). To disseminate, we distributed printed advertising materials, hosted 3 national webinars and conducted 2 virtual capacity-building training series. Results A total of 315 individuals attended the webinars, and the average WCHC knowledge increased by 29% (SD 4.3%). In total, 131 service providers engaged in 22 virtual capacity-building training sessions with 21 clinical cases discussed. Learners self-reported increased confidence in 15/15 abilities, including the ability to provide WCHC. As of December 2023, the toolkits were downloaded 7766 times. Conclusions We successfully developed WCHC toolkits and shared them with diverse clinical and community audiences through various dissemination methods

Multivariable regression model of predictors of posttraumatic stress symptoms in British Columbia (n = 341).

<p>Multivariable regression model of predictors of posttraumatic stress symptoms in British Columbia (n = 341).</p

Descriptive characteristics.

<p>Descriptive characteristics.</p

Development of the Canadian Women-Centred HIV Care Model Using the Knowledge-to-Action Framework

In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the "Women-Centred HIV Care" (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the "foundation". Person-centred care with attention with attention to social determinants of health and family make up the "first" floor. Women's health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the "second" floor. Peer support, leadership, and capacity building make up the "roof". To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Model should be flexible in its delivery (e.g., single provider, interdisciplinary clinic or multiple providers) and implementation settings (e.g., urban, rural).This work was supported by the Canadian Institutes of Health Research (CIHR) (http://www.cihr-irsc.gc.ca/e/193.html) (grant number MOP111041, CDE:144824, and FDN154325), Women’s Xchange 15 K Challenge, the CIHR Canadian HIV Trials Network (http://www.hivnet.ubc.ca/) (study number CTN 262), the Ontario HIV Treatment Network (http://www.ohtn.on.ca/), and the Academic Health Science Centres Alternative Funding Plans (AFP) Innovation Fund (https://ifpoc.org/). NO and AdP received support from Fonds de Recherche du Québec—Santé (http://www.frqs.gouv.qc.ca/en/le-frqs). AC received support from a CIHR Doctoral Award. AK received salary support through a Tier 2 Canada Research Chair in Global Perspectives on HIV and Sexual and Reproductive Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The author(s) received no financial support for the research, authorship, and/or publication of this article

Correlations of variables in final regression models with posttraumatic stress symptoms.

<p>Correlations of variables in final regression models with posttraumatic stress symptoms.</p

Multivariable regression model of predictors of posttraumatic stress symptoms in Québec (n = 327).

<p>Multivariable regression model of predictors of posttraumatic stress symptoms in Québec (n = 327).</p

Reliability of routinely collected anthropometric measurements in primary care

Background Measuring body mass index (BMI) has been proposed as a method of screening for preventive primary care and population surveillance of childhood obesity. However, the accuracy of routinely collected measurements has been questioned. The purpose of this study was to assess the reliability of height, length and weight measurements collected during well-child visits in primary care relative to trained research personnel. Methods A cross-sectional study of measurement reliability was conducted in community pediatric and family medicine primary care practices. Each participating child, ages 0 to 18 years, was measured four consecutive times; twice by a primary care team member (e.g. nurses, practice personnel) and twice by a trained research assistant. Inter- and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and a coefficient of reliability (R). Results Six trained research assistants and 16 primary care team members performed measurements in three practices. All %TEM values for intra-observer reliability of length, height, and weight were classified as ‘acceptable’ ( 99% for both intra- and inter-observer reliability. Length measurements in children Conclusion There was agreement between routine measurements and research measurements although there were some differences in length measurement reliability between practice staff and research assistants. These results provide justification for using routinely collected data from selected primary care practices for secondary purposes such as BMI population surveillance and research.</p