“It’s a big difference between having an opinion on something and actively doing it:” physician and nurse practitioner non-participation in medical assistance in dying

Medical assistance in dying (MAID) became legal in 2016 with the Royal Assent of Bill C-14. There are numerous considerations and several challenges when developing safe and sustainable MAID programs in Canada. In the face of these challenges, competent and compassionate healthcare practitioners (HCPs) who are willing to participate in the formal MAID processes of patient assessment and MAID provision are essential. This thesis included a scoping review which identified, analyzed, and synthesized the factors that influenced HCPs' non-participation in ethically complex, legally available healthcare and a qualitative exploratory study that illuminated the factors that influenced physicians and nurse practitioners (NPs) when deciding not to participate in the formal MAID processes of determining a patient’s eligibility and providing MAID. Five themed factors that influenced HCPs' non-participation in ethically complex, legally available care were identified in the scoping review. While conscientious objection (CO) frequently dominated the discourse regarding HCPs’ non-participation care, it was clear that multiple factors beyond ethical, religious, or core moral belief also influenced HCPs’ non-participation. Thirty-five non-participating HCPs were interviewed over five months in Saskatchewan, Canada in the qualitative exploratory project. Considering Social Contract Theory and Ruggerio’s approach to moral dilemmas and decision-making, the endogenous and exogenous factors that influenced their non-participation threshold were identified. Endogenously HCPs’ were influenced by their (1) previous personal and professional experiences, (2) comfort with death, (3) conceptualization of duty, (4) preferred EOL care approaches, (5) faith or spirituality beliefs, (6) self-accountability, (7) consideration of emotional labour, and (8) concern regarding future emotional impact. Exogenously, HCPs’ non-participation was influenced by (1) the healthcare system they work within, (2) the communities where they live, (3) their current practice context, (4) how their participation choices were visible to others, (5) the risks of participation to themselves and others, (6) time factors, (7) the impact of participation on the patient’s family, and (8) patient relationship and contextual factors. Non-participation in formal MAID processes occurred along a spectrum and was influenced by these complex, interwoven, and diverse endogenous and exogenous factors. This dissertation's key findings are that non-participation in ethically complex, legally available care (including MAID) includes both conscientious objection to care and non-participation in care and culminated in the development of the Model of Non-Participation in Formal MAID Processes. Practice considerations to support patients and HCPs in the evolving social contract of end-of-life care are offered to support safe and satisfying workplaces and patients' access to care

The Association of Architecture School Librarians instruction workshop \u27lessons learned\u27

Workshop Goals for session attendees — Learn how to: - relate course assignments to information competencies- identify appropriate learning outcomes- plan activities to achieve those learning outcomes- create tools to assess student learnin

Identifying patient concerns during consultations in tertiary burns services: development of the Adult Burns Patient Concerns Inventory

ObjectivesIdentifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The Patient Concerns Inventory (PCI) is a tried and tested concept initially developed in the field of head and neck cancer that empowers patients during a clinical encounter through provision of a list of prompts that allows patients to self-report concerns prior to consultation. The aim of this study was to develop a PCI for adult burns patients.DesignContent for the PCI was generated from three sources: burns health-related quality of life tools, thematic analysis of one-to-one interviews with 12 adult burns patients and 17 multidisciplinary team (MDT) members. Content was refined using a Delphi consensus technique, with patients and staff members, using SurveyMonkey.SettingWithin outpatient secondary care.ParticipantsTwelve adult burns patients and MDT members from two regional burns centres.ResultsA total of 111 individual items were generated from the three sources. The Delphi process refined the total number of items to 58. The main emergent domains were physical and functional well-being (18 items), psychological, emotional and spiritual well-being (22 items), social care and social well-being (7 items) and treatment-related concerns (11 items).ConclusionsThe Adult Burns Patient Concerns Inventory is a 58-item, holistic prompt list, designed to be used in the outpatient clinic. It offers a new tool in burn care to improve communication between healthcare professionals and patients, empowering them to identify their most pressing concerns and hence deliver a more focused and targeted patient-centred clinical encounter

L’aide médicale à mourir dans les programmes d’études en sciences de la santé : étude exploratoire qualitative

Background: This paper offers insight into (1) the driving and restraining forces impacting the inclusion of medical assistance in dying (MAID) in health sciences curricula, (2) the required resources for teaching MAID, and (3) the current placement of MAID in health sciences curricula in relation to end-of-life care concepts. Method: We conducted a qualitative exploratory study in a Canadian province using Interpretive Description, Force Field Analysis, and Change as Three Steps. We interviewed ten key informants (KI), representing the provincial health sciences programs of medicine, nursing, pharmacy, and social work. KIs held various roles, including curriculum coordinator, associate dean, or lecturing faculty. Data were analyzed via the comparative method using NVivo12. Results:  Curriculum delivery structures, resources, faculty comfort and practice context, and uncertainty of the student scope of practice influenced MAID inclusion. Medical and pharmacy students were consistently exposed to MAID, whereas MAID inclusion in nursing and social work was determined by faculty in consideration with the pre-existing course objectives. The theoretical and legal aspects of MAID were more consistently taught than clinical care when faculty did not have a current practice context. Care pathways, accreditation standards, practice experts, peer-reviewed evidence, and local statistics were identified as the required resources to support student learning. MAID was delivered in conjunction with palliative care and ethics, legalities, and professional regulation courses. Conclusion: The addition of MAID in health sciences curricula is crucial to support students in this new practice context. Identifying the drivers and restrainers influencing the inclusion of MAID in health sciences curricula is critical to support the comprehensiveness of end-of-life education for all students.Contexte : Cet article vise à explorer 1) les forces motrices et restrictives ayant un effet sur l’inclusion de l’aide médicale à mourir (AMM) aux programmes d’études en sciences de la santé, 2) les ressources nécessaires à l’enseignement de l’AMM, et 3) la place actuelle occupée par l’AMM dans les programmes d’études en sciences de la santé par rapport aux concepts de soins de fin de vie. Méthodologie : Nous avons mené une étude qualitative exploratoire dans une province canadienne en utilisant la description interprétative, l’analyse des champs de force et le changement en trois étapes. Nous avons interrogé dix informateurs clés, représentant les programmes provinciaux de sciences de la santé en médecine, sciences infirmières, pharmacie et du travail social. Ces informateurs clés assumaient diverses fonctions, entre autres celui de coordinateur du cursus, de doyen associé et d’enseignant. Les données ont été analysées par la méthode comparative en utilisant NVivo12. Résultats : Les structures des cursus, les ressources, l’aisance et le contexte de pratique des professeurs, ainsi que l’incertitude des étudiants quant à leur champ d’exercice ont tous influé sur l’inclusion de l’AMM. Les étudiants en médecine et en pharmacie ont été systématiquement exposés à l’AMM, tandis que l’inclusion de l’AMM au programme d’études en sciences infirmières et en travail social a été déterminée par le corps enseignant en tenant compte des objectifs préexistants des cours. Les aspects théoriques et juridiques de l’AMM étaient plus systématiquement enseignés que les soins cliniques lorsque le corps professoral ne disposait pas d’un contexte de pratique. Les trajectoires de soins, les normes relatives à l’homologation, les experts de la pratique, les données probantes et les statistiques locales ont été identifiés comme ressources nécessaires pour soutenir l’apprentissage des étudiants. L’enseignement de l’AMM a été dispensé en même temps que les cours sur les soins palliatifs, l’éthique, les aspects juridiques et la réglementation professionnelle. Conclusion : L’ajout de l’AMM aux cursus en sciences de la santé est crucial pour soutenir les étudiants dans ce nouveau contexte de pratique. Il est essentiel d’identifier les moteurs et les freins qui influent sur l’inclusion de l’AMM dans les cursus en sciences de la santé pour assurer la globalité de la formation sur la fin de vie pour tous les étudiants

The role of values education in primary school bullying prevention and mediation

This study explores the incidence and implications of bullying in primary school and the beliefs parents and educators share about the explicit application of a values based approach to bullying interventions and mediations. Interviews and focus group discussions explored current anti-bullying practices employed by teachers and principals. The study also examined specific values perceived to be relevant by parents and educators, in the endeavour to successfully resolve the growing incidence of bullying conflict situations and the serious implications for both victims and bullies. Individual interviews and focus group discussions were administered in three Catholic systemic primary schools to a sample group of principals, teachers and parents. This study examined the personal experiences and opinions of the participants, regarding current bullying interventions and the explicit teaching of relevant values, to achieve positive behaviour changes towards others to resolve these conflicts. The data revealed that most participants approved of mediation between bully and victim, merged with the positive aspects of restorative approach, with accountability and imposition of consequences, as the preferred intervention. An explicit core values teaching approach to assist the bully to achieve positive behaviour changes towards others was a commonality in all data collected. Specific teacher training in dealing with bullying conflicts, to achieve consistency of practice, was a strong recommendation of the study. Further research to determine the views of public and independent schools and the experiences and opinions of children directly involved in bullying conflict situations, would be beneficial for future studies, to gain a broader perspective on the preferred approach to dealing with bullying

Bullying prevention and mediation: the role of Values Education

The growing incidence of bullying in schools calls for alternative prevention and mediation approaches in which values are integrated into current practices. This study explores educators’ and parents’ beliefs about the explicit application of a values-based approach to bullying intervention and mediation in Catholic schools. Individual and focus group interview among teachers, principals and parents were held in three Catholic primary schools in the Sydney Metropolitan area. The study also served to identify current anti-bullying practices employed as well as to examine specific values perceived to be relevant by parents and educator in preventing and solving bullying conflicts. Respondents showed a preference for mediation interventions between bully and victim, drawing simultaneously on element of restorative practice, notions of accountability and imposition of consequences. Likewise, they supported a value-centred approach in dealing with the bully in order to achieve a positive behaviour. Specific professional development in dealing with bullying prevention in the practice of medication and consistency of practice were recommended. The paper also presents implication for professional development and creating an organic anti-bullying culture by incorporating values into the curriculum and examining the roles of students, parents, carers and the school

The Human Papillomavirus Type 11 E1∧E4 Protein Is Phosphorylated in Genital Epithelium

AbstractThe most abundant viral transcript in human papillomavirus (HPV) 11-infected xenograft tissue has been shown to encode the E1∧E4 protein. The function of E1∧E4 protein has not been determined. Several potential phosphorylation sequence motifs were identified in the HPV 11 E1∧E4 protein, including potential sites of phosphorylation by mitogen-activated protein kinase (MAPK), cAMP-dependent protein kinase (PKA), casein kinase II, and protein kinase C. To test phosphorylation of the HPV 11 E1∧E4 protein, a soluble maltose binding protein (MBP) fusion was produced in Escherichia coli. Only MAPK and PKA phosphorylated the E1∧E4 protein. Phosphoamino acid analysis showed that one or more threonine residues were phosphorylated by MAPK, and both serine and threonine residues were phosphorylated by PKA. MBP–E1∧E4 mutant proteins were designed to delineate the E1∧E4 phosphoacceptor residues. MAPK was shown to phosphorylate E1∧E4 on threonine 53 within a MAPK consensus phorphorylation sequence motif. PKA was shown to phosphorylate E1∧E4 at two residues: threonine 36 within a consensus motif and serine 44 within a variant of the PKA consensus phosphorylation sequence motif. HPV 11-infected human genital tissue grown as a xenograft in an athymic mouse was labeled with [32P]orthophosphate. Phosphoamino acid analysis of E1∧E4 protein immunoprecipitated from 32P-labeled tissue revealed that both serine and threonine residues were phosphorylated. Analysis by liquid chromatography–mass spectrophotometry was consistent with phosphorylation of residues within the PKA and MAPK phosphorylation sequence motifs. Expression of E1∧E4 protein containing phosphorylation substitution mutations showed that the PKA mutant did not differ from wild-type E1∧E4 protein in intracellular distribution. In contrast, the MAPK mutant did not localize exclusively to the cytoplasm nor did it colocalize with wild-type E1∧E4 protein. We conclude that HPV 11 E1∧E4 protein is phosphorylated in vitro and in vivo. Our data are consistent with phosphorylation of HPV 11 E1∧E4 protein by MAPK and PKA in infected tissue

Comparison of animal welfare assessment tools and methodologies: need for an effective approach for captive elephants in Asia

Welfare is a fundamental aspect of animal management and conservation. In light of growing public awareness and welfare concerns about captive elephants, there is an urgent need for comprehensive, globally coordinated efforts for Asian elephants (Elephas maximus) that participate in religious, logging, or tourist activities in range countries where the majority reside, and where welfare issues have been identified but not addressed. This review provides a comparative analysis of available animal assessment tools. Each offers distinct features for assessment that allow institutions to select criteria for specific needs and available resources. Most are applied to general animal welfare assessments, although some are tailored to particular species, including elephants. The tools span diverse formats, from digital to primarily paper-based assessments. Assessments operate at individual and institutional levels and across multiple welfare domains. Methodologies rely on keeper ratings or expert evaluations, incorporate numerical scoring and Likert scales for welfare grading, and encompass inputs including behaviors, health, and physiological indicators. For tourist camp elephants, one challenge is that the tools were developed in zoos, which may or may not have application to non-zoological settings. Digital tools and assessment methodologies such as keeper ratings face logistical challenges when applied across tourist venues. As with any tool, reliability, validity, and repeatability are essential and must address the unique welfare challenges of diverse captive settings. We propose that a holistic, context-specific, evidence-based, and practical tool be developed to ensure high elephant welfare standards in non-zoological facilities throughout Asia