Practice Impact of a Dedicated LGBTQ+ Clinical Exposure During Residency

Background and Objectives

An increased focus on lesbian, gay, bisexual, transgender, queer (LGBTQ+) care in graduate medical education is needed to address health disparities in this patient population. This study assessed practice confidence and practice intentions of residents who rotated through an LGBTQ+ clinic during their residency.

Methods

Residents completed three to eight half-day sessions in a dedicated LGBTQ+ clinic focusing on primary care, pre-exposure prophylaxis (PrEP), and gender-affirming care from 2019 to 2022. Prior to this clinical experience, they were provided background reading materials, care guidelines, and clinical cases. Residents were electronically surveyed at two time points after completing this clinical experience to retrospectively assess their pre-and postcurricular confidence.

Results

Seventeen out of 18 (94%) residents who completed the curricular experience responded to the initial survey, which showed statistically significant differences between reported pre- and postcurricular confidence in providing primary care, PrEP, and gender affirmation care. Eight-eight percent of residents reported that they planned to or have already incorporated this care into their practice. In a follow-up survey 1 year later, 15 out of 18 (83%) responded, reporting consistent skills confidence. Seventy-one percent of participants reported currently providing LGBTQ+ care. We noted no statistical difference between the initial postconfidence survey and the follow-up survey.

Conclusion

This study demonstrated positive associations between a focused curricular experience in LGBTQ+ care and both confidence providing LGBTQ+ care and planned and actual postgraduation practice patterns.

Longitudinal Evaluation of a Deprescribing Protocol in Skilled Nursing Facilities

Objective: To determine whether a deprescribing effort reduced several key classes of medications, and the overall number of medication classes per patient, among long-term residents of skilled nursing facilities (SNFs). Design: Retrospective, longitudinal pre/post evaluation. Data from before and during the implementation of the deprescribing effort (2017 through 2019) were compared with data from the post-intervention year (2020). Setting and Patients: Long-term resident data reported through annual comprehensive reviews conducted at two SNFs located in central New York State between 2017 and 2020 (N = 12,144). Interventions: Multifaceted, interdisciplinary deprescribing effort to reduce medications in SNF residence including clinician education, guideline development, and individual chart reviews began in 2019. Results: The mean number of medications prescribed per resident was lower at both facilities after the intervention (mean = 1.74 at both facilities) versus preintervention (1.90 at Facility 1, 1.86 at Facility 2). Significant decreases were observed in the usage rates for diuretics (-4.2%; P = 0.001), opioids (-3.8%; P = 0.001), and antipsychotics (-2.4%; P = 0.010). The raw antidepressant usage rate increased by 1.5% after the intervention but the change was not significant. Effects were robust to covariate adjustment. Conclusion: A combined, comprehensive approach to deprescribing was associated with a reduction in the overall number of medication classes per resident and in several key classes of medications. Additional research with more data and covariate control is in progress for verification of these findings.

Oxidative damage to DNA related to survivorship and carotenoid-based sexual ornamentation in the common yellowthroat

Carotenoid-based sexual ornaments are hypothesized to be reliable signals of male quality, based on an allocation trade-off between the use of carotenoids as pigments and their use in antioxidant defence against reactive oxygen species. Carotenoids appear to be poor antioxidants in vivo, however, and it is not clear whether variation in ornament expression is correlated with measures of oxidative stress (OXS) under natural conditions. We used single-cell gel electrophoresis to assay oxidative damage to erythrocyte DNA in the common yellowthroat (Geothlypis trichas), a sexually dichromatic warbler in which sexual selection favours components of the males' yellow 'bib'. We found that the level of DNA damage sustained by males predicted their overwinter survivorship and was reflected in the quality of their plumage. Males with brighter yellow bibs showed lower levels of DNA damage, both during the year the plumage was sampled (such that yellow brightness signalled current OXS) and during the previous year (such that yellow brightness signalled past OXS). We suggest that carotenoid-based ornaments can convey information about OXS to prospective mates and that further work exploring the proximate mechanism(s) linking OXS to coloration is warranted.