Unique Considerations Research Articles

Cardiac Implantable Electronic Devices in Cardiac Transplant Patients: A Comprehensive Review

A fraction of patients (approximately 10%) undergoing heart transplantation require permanent pacemaker (PPM) implantation due to sinus node dysfunction or atrioventricular block, occurring either shortly after surgery or later. The incidence of PPM implantation has declined to less than 5% with the introduction of bicaval anastomosis transplantation surgery. Pacing dependency during follow-up varies among recipients. A smaller subset (1.5–3.4%) receives implantable cardioverter-defibrillators (ICDs), but data on their use in transplant recipients are limited, primarily from cohort studies and case series. Sudden cardiac death affects around 10% of transplant recipients, attributed to various nonarrhythmic factors such as acute rejection, late graft failure, and cardiac allograft vasculopathy-induced ischemia. This review offers a comprehensive analysis of the existing data concerning the role of PPMs and ICDs in this population, encompassing leadless PPMs, subcutaneous ICDs, unique considerations, and future directions.

Challenges and Strategies in Translating Humour for Arabic Subtitling

The translation of humour in audiovisual media presents unique challenges due to its cultural relativity and dependence on social, linguistic, and cultural contexts. While Audiovisual Translation (AVT) studies have expanded since their emergence in the 1950s, research on humour translation between English and Arabic remains understudied, particularly regarding culturally sensitive content. This study addresses this gap by examining the strategies employed in translating humorous content from English to Arabic in subtitled media. Using a corpus-based approach, this research combines qualitative and quantitative methodologies to analyze translation strategies for humour, with particular attention to sensitive topics including sex, religion, and politics. The qualitative analysis examines the specific challenges and solutions in translating culturally-bound humour, while the quantitative component provides statistical data on the frequency and distribution of various translation strategies. The findings reveal that Arabic subtitlers predominantly employ Preservation strategies (50%), followed by Reduction (18.2%) and Expansion (16.7%). This pattern differs from previous studies of other language pairs, suggesting that the English-Arabic translation of humour involves unique considerations and approaches. The research contributes to AVT scholarship by providing empirical evidence of translation strategies in the understudied English-Arabic language pair and offering insights into the handling of culturally sensitive humour in Arabic subtitling practices.

Empirical Analysis of Critical Success Factors for Mechatronics Implementation in Architecture, Engineering, Construction and Operations Projects in Nigeria

The Fourth Industrial Revolution (4IR) has ushered in a new era of technological advancements that are transforming industries worldwide. One such technology that is revolutionizing the construction industry is mechatronics, which has the propensity to enhance the operations, activities, productivity and efficiency of the sector’s activities. Despite the numerous advantages of mechatronic technologies, their successful implementation in the context of developing countries poses unique challenges and considerations. Therefore, this study seeks to identify and evaluate the critical success factors (CSFs) for mechatronics implementation in architecture, engineering, construction and operations (AECO) projects. Existing CSFs were extracted from extant studies, which helped formulate the questionnaire disseminated to 372 construction professionals in Nigeria, including architects, builders, quantity surveyors, and engineers (mechanical, civil, electrical). The methodology also employed exploratory factor analysis (EFA), which facilitated the identification of key themes within the data. Through this application, six clusters of CSFs were revealed: organizational factors, financial considerations, technological aspects, collaboration and knowledge sharing, regulatory and policy factors, and sustainability and environmental considerations. From a theoretical perspective, the identified clusters of critical success factors provide a comprehensive framework that encompasses various dimensions of successful mechatronics adoption in the Nigerian construction industry. This study advances scientific knowledge on CSFs for the adoption of mechatronic technologies in the Nigerian construction industry, providing a comprehensive understanding of the factors that drive successful implementation. For policymakers, this study’s findings will be invaluable in shaping supportive policies and strategies that foster the widespread adoption of mechatronics in the construction sector.

Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study

BackgroundDuring the COVID-19 pandemic, virtual visiting technologies were rapidly integrated into the care offered by intensive care units (ICUs) in the UK and across the globe. Today, these technologies offer a necessary adjunct to in-person visits for those with ICU access limited by geography, work/caregiving commitments, or frailty. However, few empirical studies explore the ethical issues associated with virtual visiting. This study aimed to explore the anticipated or unanticipated ethical issues raised by using virtual visiting in the ICU, such that healthcare professionals can be informed about how to carry out virtual visits ethically, safely and productively.MethodsWe used a descriptive exploratory qualitative research approach recruiting a convenience sample of newly-graduated junior doctors facilitating ICU virtual visits in a tertiary academic centre. Eight newly graduated junior doctors, seven female and one male, aged 23–27, participated in semi-structured interviews. We analysed transcripts using an inductive coding approach.ResultsFive overarching themes emerged. Two of the themes namely, ‘fulfilling a moral instinct to connect families’ and ‘promoting autonomy’, arose from participants’ descriptions of how virtual visits aligned with healthcare standards and practices they considered ethical. Three further themes, ‘preserving dignity and privacy’, ‘managing emotional distress’, and ‘providing equitable access’ to virtual visiting technologies, highlight how virtual visits might exacerbate ethical issues related to family communications.ConclusionVirtual visiting may potentially both ameliorate and exacerbate aspects of ethical healthcare delivery for ICU patients and family members. ICU team members should consider unique ethical considerations related to using virtual visiting. We recommend virtual communications skills training for staff and advocate for the use of easily accessible educational resources for families who wish to visit critically unwell patients remotely.

Adult Asymmetrical Tonsils: Case Series

Asymmetrical tonsil enlargement in adults may stem from various underlying pathologies, including infectious, inflammatory, and neoplastic processes. Differential diagnoses may include but are not limited to, chronic tonsillitis, peritonsillar abscess, tonsillar hypertrophy, lymphoma, and squamous cell carcinoma. Each differential presents unique clinical features, diagnostic challenges, and management considerations, highlighting the need for a comprehensive approach to patient assessment. This case series will explore the clinical presentations, diagnostic workup, and therapeutic interventions employed in managing adult patients with asymmetrical tonsil enlargement. We aim to facilitate early detection, appropriate treatment, and optimal outcomes for affected individuals by emphasizing the importance of considering a broad range of differentials.

To Conceal or to Reveal? Antecedents of Ethnic Minority Family Businesses’ Use of Ethnic Branding

The family business branding literature identifies numerous benefits to communicating family ownership. However, existing studies have omitted ethnic minority family businesses (EMFB), which present unique identity and cultural considerations. We examine potential antecedents to EMFB use of ethnic branding, which features their ethnicity within marketing communications. The study establishes a significant positive relationship between EMFB owners’ ethnic identification and socioemotional wealth (SEW), and between EMFB owners’ SEW and ethnic branding usage. Product ethnicity moderates the latter relationship such that a match between product ethnicity and EMFB ethnicity increases the likelihood of ethnic branding. Managerial and theoretical implications are further discussed.

Clinical Care of Acne Vulgaris for Transgender and Gender Diverse Youth

Abstract Primary care providers have reported feeling ill-equipped to care for transgender and gender diverse (TGD) patients because of lack of training, and their treatment of acne has been shown to be variable and not standardized. This is an important practice gap, as TGD youth represent a historically underserved population in medicine, despite data suggesting that up to 9.2% of high school–age adolescents identify as TGD. Although needs and expectations for quality health-care in TGD youth do not necessarily differ from their cisgender peers, TGD adolescents have unique considerations in their care and are at risk for negative social and emotional outcomes secondary to minority stress, discrimination, and rejection by peers and family. Acne is estimated to affect approximately 85% of adolescents and is associated with negative mental health outcomes, including suicidal ideation, low self-esteem, and depression. As such, knowledgeable and culturally informed care of acne in TGD adolescents has important implications for quality of life for patients who desire effective treatment. This review article addresses these practice gaps by summarizing an approach to acne evaluation and management with an emphasis on appropriate regimens for TGD youth, and the unique psychosocial and medical considerations for this population.

Anesthetic management for aspiration thrombectomy using the Penumbra Indigo System® in pediatric patients with congenital heart disease

ObjectivesDescribe clinical characteristics and outcomes including transfusion requirements of pediatric patients with congenital heart disease undergoing aspiration thrombectomy DesignRetrospective chart review SettingQuaternary academic children's hospital ParticipantsPatients < 18yrs with congenital heart disease undergoing aspiration thrombectomy from November 2017-February 2022. Measurements and main results13 patients underwent mechanical thrombectomy with the Penumbra Indigo System®. Median age was 3.8 years and median weight was 15.2kg. Seven patients had palliated single ventricle and 6 had biventricular circulation. Nine patients were receiving ICU care pre-procedure and 12 required ICU care post-procedure. Indications for thrombectomy included systemic venous thrombus (n=7), pulmonary arterial thrombus (n=3), systemic arterial thrombus (n=2), and systemic to pulmonary shunt occlusion (n=1). Median estimated blood loss was 7.7ml/kg (interquartile range 1.4ml/kg-15.8ml/kg, range 0.5ml/kg-51.5ml/kg). Seven patients required intraoperative transfusion of pRBCs (n=4), FFP (n=2), platelets (n=3), and/or cryoprecipitate (n=1). In those requiring transfusion, median transfusion volume was 22ml/kg (interquartile range 15.5ml/kg-76.5ml/kg, range 9.3ml/kg-132.8ml/kg). Thrombectomy was successful in 8 of 13 patients, although 3 experienced recurrent thrombosis. ConclusionsMechanical aspiration thrombectomy is increasingly used to treat critically ill pediatric patients and presents unique anesthetic considerations particularly related to the need for volume and blood product resuscitation

MACRO STRUCTURE OF BILINGUAL (ENGLISH-KARAKALPAK) DICTIONARIES

This article examines the macro structure of bilingual English-Karakalpak dictionaries, highlighting the unique challenges and considerations in lexicographical organization. The macro structure, which encompasses the arrangement and organization of dictionary entries, plays a crucial role in ensuring user accessibility and practical functionality, particularly in bilingual dictionaries. The study begins with a theoretical overview of lexicographic principles, distinguishing between macro and micro structures and discussing common challenges in bilingual dictionary compilation. Key aspects of macro structuring, such as alphabetical organization, entry selection criteria, handling of dialects and loanwords, and cross-referencing systems, are analyzed in the context of English-Karakalpak dictionaries. Ultimately, this article underscores the critical role of well-structured bilingual dictionaries in preserving the Karakalpak language and supporting bilingual education and cultural exchange.

Safety of Small-Diameter Endotracheal Tubes in Microlaryngeal Surgery.

Microlaryngeal surgeries require unique considerations for airway management to facilitate patient safety and adequate surgical exposure. Small-diameter endotracheal tubes (ETTs) are widely used but have raised concerns regarding patient safety, including questions about the potential for barotrauma, effective ventilation, and adequate oxygenation. We hypothesize that small ETTs will prove to be safe in a variety of cases. We conducted a case series analyzing the safety of 5.0 ETTs in microlaryngeal surgeries at Washington University School of Medicine from November 2020 to November 2023. Outcome measures included intraoperative desaturations (SpO2 < 90% for >2 min), high peak inspiratory pressures (PIPs) (>40 cm H2O), and prolonged extubation times (>15 min). Univariate regression models were used to analyze associations of sociodemographic and clinical variables with these outcome measures. This study included 76 small-ETT microlaryngeal surgeries. There were 5 instances of desaturations, no reported incidents of barotrauma, and no cases in which intraoperative tube exchange was required due to issues with oxygenation or ventilation. Median PIP was 38 cm H2O, with a range of 17-78 cm H2O. 46% of patients had a PIP above 40 cm H2O. There were prolonged extubation times in 14% of procedures. No association was shown between sociodemographic and clinical variables with risk of desaturations, high PIPs, or prolonged extubation times. Our study suggests that 5.0 ETTs are safe for microlaryngeal surgery in a variety of patients. Otolaryngologists and anesthesiologists should consider this information when choosing between the multiple available options for airway management during microlaryngeal surgery. Level 4 Laryngoscope, 2024.

Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults.

Approximately one in three older adults (aged 65 years and over) experience pain, negatively impacting their quality of life. Opioid analgesics are commonly prescribed to manage pain; however, balancing the benefits and harms of these high-risk analgesics can be challenging for both healthcare professionals and patients. This is particularly true for older adults, as factors such as polypharmacy, age-related physiological changes and cognitive decline may impact upon opioid safety and efficacy. Deprescribing is the patient-centred process of reducing or discontinuing a medication that is no longer appropriate, or where the risks of continuation are deemed to outweigh the anticipated benefits. Opioid deprescribing has been proposed as a mechanism to reduce individual and societal opioid-related harm; however, to date, research has predominantly focused on the general adult population, rather than older adults. This current opinion aims to summarise the existing opioid deprescribing literature, discussing its applicability for older adults. Drawing on a non-systematic review of the literature, it identifies unique challenges and considerations for this population, highlights international initiatives to enhance opioid deprescribing in clinical practice and proposes future directions to advance the field.

A Review of Wastewater-Based Epidemiology for the SARS-CoV-2 Virus in Rural, Remote, and Resource-Constrained Settings Internationally: Insights for Implementation, Research, and Policy for First Nations in Canada

Wastewater-based epidemiology (WBE) is regarded as a support tool for detecting and assessing the prevalence of infectious diseases at a population level. For rural, remote, and resource-constrained communities with little access to other public health monitoring tools, WBE can be a low-cost approach to filling gaps in population health knowledge to inform public health risk assessment and decision-making. This rapid review explores and discusses unique considerations of WBE in key settings, with a focus on the detection of the SARS-CoV-2 virus, which has rapidly expanded WBE infrastructure globally. To frame our understanding of possibilities for WBE with First Nations in Alberta, we address the following questions: What are the unique considerations and challenges for WBE under similar contexts in rural, remote, or resource-constrained settings? What are the resources and expertise required to support WBE? This review identifies several unique considerations for WBE in rural, remote, and resource-constrained communities, including costs, accessibility, operator capacity, wastewater infrastructure, and data mobilization—highlighting the need for equity in WBE. In summary, most resource-constrained communities require additional support from external research and/or governmental bodies to undertake WBE.

Challenges and possibilities in adolescent loneliness interventions

Abstract Researchers typically associate the high prevalence of loneliness during adolescence with evolving dynamics and changes in relationships, both familial and peer-related. Consequently, transient feelings of loneliness are anticipated and considered part of the normative developmental process. While many adolescents naturally navigate through periods of loneliness by reconnecting with peers, a subset experiences prolonged feelings of loneliness. This group faces an increased risk of additional mental health issues and potential adverse health consequences. Such findings underscore the importance of effective and scalable interventions. This presentation draws upon a comprehensive meta-analytical review of loneliness interventions and a dedicated chapter in the upcoming Cambridge Handbook of Loneliness. focusing on interventions for adolescents. It will offer a brief overview of contemporary loneliness interventions and intervention strategies. Furthermore, it will discuss the unique considerations required when addressing loneliness in adolescents compared to other age groups. This includes the critical importance of loneliness prevention for adolescents, particularly within the school environment. Furthermore, the presentation will discuss the potential of community-based interventions aimed at tackling adolescent loneliness, showcasing the ongoing Danish community-based intervention ‘More Together.’ ‘More Together’ is a large-scale, complex, multi-component and multi-level intervention for community change that aims to reduce loneliness among young and elderly people. The intervention is rooted in an extensive cross-sector partnership. The presentation will highlight potentials and pitfalls encountered when addressing adolescent loneliness within a community setting.

Genital Gender-Affirming Surgery Requests Outside the Binary: Unique Multidisciplinary Considerations for Transgender and Gender Diverse Patients

Genital Gender-Affirming Surgery Requests Outside the Binary: Unique Multidisciplinary Considerations for Transgender and Gender Diverse Patients

Purple urine bag syndrome: a unique clinical case and management considerations

Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora breaks down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes are present. The breakdown products, indigo, and indirubin appear blue and red. We reported on an elderly woman who was kept in a nursing home, had multiple comorbidities such as history of cerebrovascular accident (CVA), acute kidney injury (AKI) and she was hospitalized due to decreased consciousness, fever and kidney failure. On the third day of hospitalization, the patient developed PUBS while undergoing urinary catheterization in the hospital. She had no history of previous catheterization and chronic use of antibiotics, she was only using Tolterodine for a long time due to urinary urgency. Due to antibiotic resistance, the drugs were not changed and the purple color disappeared after changing the catheter and urinary bag.This was the first patient in this region to be reported with this manifestation.

06 Eating disorder toolkit 2023: Standards of practice in the primary care setting

Abstract Background Throughout the COVID 19 pandemic, physicians across Canada began to see a 'shadow pandemic' unfold as new diagnosis of eating disorders and hospital admissions for patients with medically unstable eating disorders increased exponentially. As these rates remain high, specialists stressed the importance of the role primary care physicians play in the early recognition, assessment, and diagnosis of eating disorders as a way to improve prognosis. Further, the high volume of patients has resulted in the need to manage patients in the community or engage in collaborative care between the eating disorder specialist and primary care physician. This Eating Disorder Toolkit was created as a knowledge mobilization resource to provide primary care and community providers with Standards of Practice and improve care for eating disorder patients. Objectives 1. Provide an updated and easily readable evidence-based reference tool for PCPs 2. Clarify PCPs role in working with, monitoring, and treating EDs in a shared care model 3. Strive for early diagnosis and connection to care for improved prognosis and decreased morbidity 4. Highlight unique considerations for specific populations 5. Align with the upcoming Eating Disorders Pathway project Design/Methods The first edition of the ED Toolkit was reviewed and based on feedback sought and provided by key partners including PCPs already using the Toolkit, areas of improvement were identified. These included formatting to improve accessibility in the primary care setting, updating the guidelines, and including unique considerations for specific populations. A literature review of current guidelines and practices internationally was completed. Experienced paediatric and adult ED specialists reviewed the material to ensure it was appropriate for clinical practice. Key partners contacted for feedback and collaboration included the Provincial ED Steering Committee, Provincial ED Pathway Project Committee, UBC Continuing Professional Development, and Primary Care physicians. This ensured the resource was meeting PCPs identified needs and was usable in the primary care setting. Edits were made to reflect the feedback received. Finally, the resource was reviewed to ensure alignment with the upcoming Provincial ED Pathway Project. Results The Eating Disorder Toolkit 2023: Standards of Practice in the Primary Care Setting is now available and has been distributed widely across British Columbia. In addition, Kelty Mental Health and Compass, leading resource hubs in the province, host the live document on their sites. Finally, the toolkit is also provided to any health providers upon request to their regional ED clinic. While we have not formally studied the outcome of this resources, anecdotal reports via email and verbal feedback from nurse practitioners, paediatricians, and ED specialists across the province has been positive. Conclusion Eating disorders are complex illnesses associated with significant medical and psychiatric complications. Early recognition and management improves prognosis. Community providers play a crucial role in recognizing and managing these patients, however many do not have expertise in this area. It is hoped that this resource will support PCPs in managing ED patients in British Columbia and there may be a potential scope for use across Canada with adaptations to local guidelines and resources.

Reflexology specific guidance for using the template for the intervention description and replication (TIDieR): A delphi study

IntroductionReflexology is a holistic, complementary therapy, carried out on the feet, hands, ears, or face. There is no single accepted definition of reflexology, as it encompasses various practices, making it important that research studies articulate exactly what the reflexology intervention entailed.This study sought to produce reflexology-specific guidance for researchers and practitioners, for use with the Template for the Intervention Description and Replication (TIDieR) checklist, to improve the quality of the documentation of reflexology interventions within the research literature. MethodThis study used the TIDieR checklist as a framework for a three-round Delphi process to gain agreement on what information authors should consider including in their study report to support replication of their intervention. Following the Delphi process two online consolidation meetings were held to agree the wording and examples for the guidance document. ResultsGuidance based on the unique considerations of reflexology interventions was developed for use with the TIDieR checklist.A diverse group of 43 experts from Europe, North America, Asia, and Australasia, including 40 reflexologists, 9 of whom were also study authors, and 2 methodological specialists contributed to the guidance.Each Delphi round was completed by 39 to 42 (91 % to 98 %) of the 43 panel members, and 16 (37 %) participated in the consolidation meetings. Consensus was reached on 46 items via the Delphi rounds (36 to be included in the guidance and 10 to be excluded); 38 items failed to reach consensus. The consolidation meetings informed the final wording of the guidance document, covering all the 12 TIDieR domains. ConclusionThe reflexology-specific guidance strongly advocates for the utilisation of the TIDieR checklist, with elaboration tailored for reflexology as used in various contexts internationally. By serving as a reporting guide for reflexology intervention studies, this tool has the capacity to improve the reporting of reflexology intervention studies, thereby facilitating replicability and promoting greater transparency within the field of reflexology.

Perioperative medication therapy for Muslim patients in Germany undergoing oncological surgery: a retrospective study

PurposeEngagement of healthcare professionals with patients from diverse cultural and religious backgrounds is crucial in our multicultural society, where miscommunication and errors in medical history taking can lead to incorrect treatment. In particular, Muslim patients may present unique considerations due to their specific cultural and religious beliefs, which can significantly impact treatment outcomes. This study focuses on perioperative medication therapy for patients undergoing upper and lower gastrointestinal tract and pancreatic tumor surgery, specifically examining whether Islamic beliefs were duly considered in medication selection compared to a matching patient cohort.Materials and methodsData from January 2004 to July 2023 were analyzed. Muslim patients were identified using the onomastic method and matched with non-Muslim patients at a 1:3 ratio based on age, gender, and procedure. Analysis included examination of subcutaneous, oral, and intravenous medications, with attention to ingredients and compatibility with Islamic principles.ResultsAmong 5272 patients, only 5 met the study’s inclusion criteria as Muslim patients, undergoing procedures such as anterior rectum resection, gastrectomy, and pancreatic head resection. Their religious affiliations were not documented in the admission records. According to the matched-pair analysis, consistent treatment was performed regardless of religious beliefs. All patients received subcutaneous medication, primarily enoxaparin, instead of fondaparinux, an Islam-compliant alternative. Intravenous heparin was used once for short period. Contrary to Islamic dietary restrictions and the availability of alternatives, capsules containing animal-derived gelatin and other non-compliant medications were administered orally.ConclusionThis study underscores the importance of acknowledging Muslim patients’ cultural and religious backgrounds in the perioperative setting, as failure to do so may lead healthcare professionals to overlook their potential alternative medication needs, which are essential for providing tailored medical care in modern societies. Integration of diversity-related topics into medical curricula is essential for better preparing physicians for clinical practice and ensuring patient-centered care.

Fungal Shoulder Periprosthetic Infections: A Systematic Review.

Background: Data regarding fungal PJIs of the shoulder are scarce. The present systematic review aims to identify and evaluate all published shoulder fungal PJIs in an effort to better understand the diagnostic and therapeutic approach to these infections. Methods: A systematic review according to the PRISMA guidelines was conducted, locating all shoulder fungal PJIs. The initial search located 1435 articles. Data were collected on demographics, the causative fungus, antifungal treatment (AFT), surgical interventions, and infection outcomes. Results: After screening and implementation of the inclusion criteria, a total of 10 articles, including 10 cases, were eligible. The sample's mean age was 62.44 years. Diabetes mellitus was the most common comorbidity (30%), while 70% were immunocompromised. Candida spp. was the most common causative fungus (nine cases; 90%), while all cases were confirmed with cultures. In three cases (30%), there was bacterial co-infection. The mean duration of antifungal treatment (AFT) was 8.4 weeks, while the preferred agent was fluconazole (60% of cases), followed by amphotericin B (30%). Most cases (50%) underwent resection arthroplasty as part of the treatment, while two-stage revision arthroplasty was performed in 30%. Infection's eradication was reported in 90% of the studied cases. Conclusions: The diagnosis and management of fungal periprosthetic shoulder infections are particularly challenging and require a multidisciplinary approach. The combination of antifungal therapy and tailored surgical strategies is crucial, but further research is needed to refine treatment protocols and address the unique considerations in shoulder PJIs.

Exploring Genetic Counselors' Experiences with Indigenous Patient Populations.

This study investigates the preparedness of genetic counselors in addressing the potentially unique elements and considerations of Indigenous patients in the United States and Canada. Considering the healthcare disparities Indigenous populations face, particularly in specialty care, this study aims to assess the preparedness of genetic counselors in addressing the unique needs and cultural considerations of Indigenous patients. An online survey was utilized, and a subset of participants was selected to be interviewed. Results reveal genetic counselors felt less competent with Indigenous patients compared to non-Indigenous patients, especially in specific aspects of genetic counseling such as responding to cultural issues or identifying resources. Factors such as increased years of experience and more exposure to Indigenous populations during graduate training correlated with higher self-rated competency. Despite a patient population that is on average 7% Indigenous by self-report, genetic counselors lacked exposure to Indigenous encounters in graduate programs and professional training. These findings underscore the importance of enhancing genetic counseling education and exposure to Indigenous training opportunities such as voluntary events or Indigenous guest speakers to improve cultural competency and address healthcare disparities for Indigenous communities.