A Cross-Sectional Study of Palliative Care Nurse Attitudes Toward Medical Assistance in Dying

Background: In 2015, the Supreme Court of Canada decriminalized physician assisted dying for persons suffering grievous and irremediable medical conditions. In Canada, Medical Assistance in Dying (MAiD) is not provided by professional nurses; however, nurses are involved in providing physical care, education, and support for persons who are in various stages of the process. Its integration in palliative care settings has been controversial as MAiD is philosophically at odds with a palliative care approach that seeks to neither hasten nor prolong natural death. Therefore, it has potential to create moral and ethical distress among palliative care nurses who respect adherence to the tenets of palliative care. Objectives: The objectives of this study were to explore the attitudes of palliative care nurses toward MAiD and to identify their professional support needs. Methods: We conducted a cross-sectional survey of palliative care registered nurses and registered practical nurses in Ontario, Canada. Letters that provided a link to an online survey were sent to participants by standard mail. Participants completed a novel instrument, the Nurse Attitudes Toward MAiD Scale (NATMS) that included 24 items ranked on a 5-point Likert-type scale (1= ‘strongly disagree’ to 5= ‘strongly agree’). Data analyses included univariate and bivariate statistics, and linear regression. Results: The final sample (N=239) included 173 registered nurses and 66 registered practical nurses who had worked in nursing for \u3e20 years, and in palliative care for \u3e10 years. The overall score on the NATMS was 3.42 + 0.62. Perceived expertise in the social domain of palliative care (β = 0.16; p=0.02), personal importance of religion/faith (β = -0.40; p=0.00), professional importance of religion/faith (β = -0.22; p=0.01) and nursing designation (β=-.18; p=0.03) predicted the NATMS score. Ethics training and clear policies for MAiD integration were reported as required supports in palliative care work environments. Conclusions: This is the first study to reveal the perceived importance of religion, versus religious affiliation alone, as significant in influencing provider attitudes toward assisted dying. Organizations are encouraged to address the professional needs of palliative care nurses. To support MAiD integration, further research is needed to understand differences in attitudes between registered nurses and registered practical nurses, and how the social domain of palliative care influences nurse attitudes toward MAiD

First Workshop on Regional Approaches to Stockpile Reduction in Southeast Europe

Faced with the significant security and humanitarian impacts of stockpiled weapons and munitions, countries and organizations in Southeast Europe met in May to discuss strategies for stockpile reduction. The workshop, held in Croatia, focused on regional approaches to this problem, emphasizing information-sharing and coordination across borders

Anti-obesity Medications Prescribing Measures Utilized by Primary Care Practitioners: Scoping Review

Background Obesity is a chronic, complex and multifactorial disease with the prevalence increasing in North American adults. Novel AOMs are demonstrating weight loss results comparable to bariatric surgery when used effectively. As the gatekeepers to AOMs, primary care providers can play a key role in obesity management through exploring safe prescribing measures employed in primary care. Objectives This review will systematically map the existing literature on prescribing measures for AOMs to determine the extent, range, and nature of literature available on the measures utilized by PCPs when prescribing AOMs in North America. Methods One independent reviewer conducted a review using the PRISMA-SCR and JBI methodology. Pubmed, CINAHL, Cochrane, OVID databases were searched between October 9 and December 1. A 10 year date restriction was applied to reflect current practice. Results There were 11 sources included in this review of which ten were quantitative studies. These sources identified barriers and facilitators with safe prescribing measures, counselling and uptake of clinical guidelines pertaining to use of AOMs. Conclusions This review identified that lack of knowledge and time were common barriers for the safe prescribing, counsel and follow, and utilization of clinical guidelines when using AOMs by PCPs

Metallkomplexe mit biologisch wichtigen Liganden, LXV

Cp*Co(CO)I2 (Cp* = 5-C5Me5), [(6-arene)RuCl2]2 (arene = p-cymene, hexamethylbenzene), and [Cp*MCl2]2 (M = Rh, Ir) react with -amino amides and various peptide esters to give the N,O-chelate complexes [Cp*(I)Co - NH2C(H)(R1)C(NHR2)-O]+ (1), [(6-arene)(Cl)Ru - NH2C(H)(R1)C(NHR2)O]+ (2), and [CP*(Cl)M - NH2CH2C(NHR)O]+ (M = Rh, Ir) (5, in solution), respectively. In the solid state the ligands are 1N-bonded in 5. By deprotonation of the peptide bond in 2 and 5 the neutral N, N-chelate complexes (6-arene)(Cl)Ru - NH2C(H)(R1)C(O)-2 (6) and Cp*(Cl)M - NH2C(H)(R1)C(O)NR2 (M = Rh, Ir) (7) have been obtained. Glycinenitrile is 1-bonded in (6-p-cymene)(Cl)2Ru(NH2CH2CN) (3) and Cp*(Cl)2Rh(NH2CH2CN) (4). Double deprotonated triglycine methyl ester is a N,N,N-tridentate ligand in (6-C6Me6)Ru(NH2CH2C(O)NCH2C(O)-NCH2CO2Me) (8). The anions of L-asparagine and of aspartame (L-aspartyl-L-phenylalanine methyl ester) give the complexes 9-12 with tridentate O,N,O- or O,N,N-chelate ligands. The crystal structures of 1d (L = glyglyOEt), 5a (L = glycinamide), 6e (L = glyglyOEt), and 7k (L = glyglyglyOEt) have been determined by X-ray structural analysis

Acting on incidental findings in research imaging

No abstract available

Estimating EQ-5D utilities based on the Short-Form Long Term Conditions Questionnaire (LTCQ-8)

Purpose: The aim of this work was to develop a mapping algorithm for estimating EuroQoL 5 Dimension (EQ-5D) utilities from responses to the Long-Term Conditions Questionnaire (LTCQ), thus increasing LTCQ’s potential as a comprehensive outcome measure for evaluating integrated care initiatives. Methods: We combined data from three studies to give a total sample of 1334 responses. In each of the three datasets, we randomly selected 75% of the sample and combined the selected random samples to generate the estimation dataset, which consisted of 1001 patients. The unselected 25% observations from each dataset were combined to generate an internal validation dataset of 333 patients. We used direct mapping models by regressing responses to the LTCQ-8 directly onto EQ-5D-5L and EQ-5D-3L utilities as well as response (or indirect) mapping to predict the response level that patients selected for each of the five EQ-5D-5L domains. Several models were proposed and compared on mean squared error and mean absolute error. Results: A two-part model with OLS was the best performing based on the mean squared error (0.038) and mean absolute error (0.147) when estimating the EQ-5D-5L utilities. A multinomial response mapping model using LTCQ-8 responses was used to predict EQ-5D-5L responses levels. Conclusions: This study provides a mapping algorithm for estimating EQ-5D utilities from LTCQ responses. The results from this study can help broaden the applicability of the LTCQ by producing utility values for use in economic analyses