ObjectivesTo determine the prevalence and correlates of Mycoplasma genitalium (MG) infection among men and women, determine the prevalence of gene mutations conferring resistance and compare test performance of female specimen types.MethodsA cross-sectional study was conducted on specimens collected for gonorrhoea (NG, Neisseria gonorrhoeae) and chlamydia (CT, Chlamydia trachomatis) among male and female Alberta STI clinic attendees using the M. genitalium transcription-mediated amplification-research use only test. Positive specimens were sequenced for 23SrRNA, parC and gyrA genes. Gender-stratified analysis compared test results using χ2 or Fisher’s exact test, Mann-Whitney U test and logistic regression. Female endocervical and urine specimens were compared.ResultsA total of 2254 individuals were tested; 53.8% (n=1212) were male. Male prevalence of MG was 5.3%; CT was 5.9% and NG was 1.8%. Correlates of male infection were a non-gonococcal urethritis diagnosis and NG coinfection. MG prevalence for women was 7.2%; CT was 5.8% and NG was 1.8%. Correlates of female infection were younger age, Indigenous/Other ethnicity and CT/NG coinfection. Nearly two-thirds of eligible specimens had mutations associated with macrolide resistance and 12.2% of specimens had a parC mutation signifying possible moxifloxacin resistance. There was high concordance (98.1%) of results between urine and endocervical swabs.ConclusionsThe high prevalence of MG relative to CT and NG supports the incorporation of MG testing into routine sexually transmissible infection screening. The high rate of resistance to macrolides and moxifloxacin raises concerns about treatment options. The good concordance of results between urine and endocervical swabs supports the use of female urine specimens for testing.

Objectives Understanding the epidemiology of invasive Candida infections is essential to patient management decisions and antifungal stewardship practices. This study characterized the species distribution and antifungal susceptibilities of prospectively collected isolates of Candida species causing bloodstream infections (BSIs) in patients admitted to tertiary care hospitals located in 14 cities across 8 of the 10 Canadian provinces between 2011 and 2016. Methods Antifungal susceptibility testing was performed by broth microdilution using CLSI methods, breakpoints and epidemiological cut-off values. DNA sequencing of fks loci was performed on all echinocandin-non-susceptible isolates. Results Candida albicans (49.6%), Candida glabrata (20.8%) and Candida parapsilosis complex (12.0%) were the most common species out of 1882 isolates associated with BSIs. Candida tropicalis (5.2%), Candida krusei (4.3%), Candida dubliniensis (4.1%), Candida lusitaniae (1.4%) and Candida guilliermondii (1.1%) were less frequently isolated. Between 2011 and 2016, the proportion of C. albicans significantly decreased from 60.9% to 42.1% (P < 0.0001) while that of C. glabrata significantly increased from 16.4% to 22.4% (P = 0.023). C. albicans (n = 934), C. glabrata (n = 392) and C. parapsilosis complex (n = 225) exhibited 0.6%, 1.0% and 4.9% resistance to fluconazole and 0.1%, 2.5% and 0% resistance to micafungin, respectively. Mutations in fks hot-spot regions were confirmed in all nine micafungin non-susceptible C. glabrata. Conclusions Antifungal resistance in contemporary isolates of Candida causing BSIs in Canada is uncommon. However, the proportion of C. glabrata isolates has increased and echinocandin resistance in this species has emerged. Ongoing surveillance of local hospital epidemiology and appropriate antifungal stewardship practices are necessary to preserve the utility of available antifungal agents.

BackgroundAdvanced practice registered nursing (APRN) competencies exist, but there is no structure supporting the operationalization of the competencies by APRN educators. The development of a Mastery Rubric (MR) for APRNs provides a developmental trajectory that supports educational institutions, educators, students, and APRNs. A MR describes the explicit knowledge, skills, and abilities as performed by the individual moving from novice (student) through graduation and into the APRN career.MethodA curriculum development tool, the Mastery Rubric (MR), was created to structure the curriculum and career of the nurse practitioner (NP), the MR-NP. Cognitive task analysis (CTA) yielded the first of the three required elements for any MR: a list of knowledge, skills, and abilities (KSAs) to be established through the curriculum. The European guild structure and Bloom’s taxonomy of cognitive behaviors provided the second element of the MR, the specific developmental stages that are relevant for the curriculum. The Body of Work method of standard setting was used to create the third required element of the MR, performance level descriptors (PLDs) for each KSA at each of these stages. Although the CTA was informed by the competencies, it was still necessary to formally assess the alignment of competencies with the resulting KSAs; this was achieved via Degrees of Freedom Analysis (DoFA). Validity evidence was obtained from this Analysis and from the DoFA of the KSAs’ alignment with principles of andragogy, and with learning outcomes assessment criteria. These analyses are the first time the national competencies for the NP have been evaluated in this manner.ResultsCTA of the 43 NP Competencies led to seven KSAs that support a developmental trajectory for instruction and documenting achievement towards independent performance on the competencies. The Competencies were objectively evaluable for the first time since their publication due to the psychometric validity attributes of the PLD-derived developmental trajectory. Three qualitatively distinct performance levels for the independent practitioner make the previously implicit developmental requirements of the competencies explicit for the first time.DiscussionThe MR-NP provides the first articulated and observable developmental trajectory for the NP competencies, during and beyond the formal curriculum. A focus on psychometric validity was brought to bear on how learners would demonstrate their development, and ultimately their achievement, of the competencies. The MR-NP goes beyond the competencies with trajectories and PLDs that can engage both learner and instructor in this developmental process throughout the career.

Many nurse practitioner specialties are requiring that basic primary care be included in their curricula. However, some experienced faculty within the specialty lack primary care experience. With a national shortage of nursing faculty, it is more important than ever to maximize available resources without overtaxing faculty workloads. Revision of our primary care practicum allowed nurse-midwifery faculty to lead a primary care clinical conference, using Family Nurse Practitioner (FNP) faculty as primary care experts. We revamped the clinical conference time to simulate clinical visits to guide the students through the clinical reasoning process. Low-fidelity simulation allowed students time to take a systematic approach to patient assessment, planning, and charting. The FNP "experts" were used to critique student chart notes prior to grading. This collaborative approach to the primary care clinical conference was well received by students, faculty, and preceptors and was quick and inexpensive to implement.

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