What Facilitates Green Team Success in Implementing Environmentally Sustainable Initiatives in Health Care

Objective: To identify the factors that contribute to the success of environmentally sustainable initiatives in health care. Background: Climate change contributes to severe health consequences for global populations. Despite mandates of nonmaleficence and health promotion, resource intensive health care systems contribute to increasing climate change. Health care professionals have been called to mitigate the environmental impact of the health care system. Nurses are particularly important in this work as they are an integral part of health care systems and are the primary providers of care in hospitals, which are the most resource intensive institutions within health care. Nurses are encouraged to engage in climate action by creating, leading, or participating in green teams to enact environmental sustainability initiatives. Methods: In this study, an integrative review of the literature was performed. The search strategy employed three electronic databases. After inclusion criteria were considered, 13 studies were included in the final sample. Content analysis was used to analyze these studies for patterns, themes, and relationships. Results: Policy, external collaboration, organisation, and staff engagement were four mainthemes of facilitative factors that contributed to the success of environmentally sustainable initiatives in health care. Conclusion: Knowledge about the facilitative factors identified and examined in this review could guide nurses to reduce health care’s environmental impact through successful environmentally sustainable initiatives

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Nurses as Boundary Actors in Sustainable Health Care: A Discussion Paper

The devastating global health impacts of climate change are becoming more apparent and more frequent. Health care systems are increasingly burdened by the response to these impacts. Paradoxically, as they respond to the negative health effects of climate change, these same resource intense health care systems are contributing to further climate change. Organizations and academics have issued a call to action for health care workers to mitigate climate change and promote environmental sustainability. Nurses are an integral part of health care systems but have been delayed in answering this call. In this paper we argue that nurses are particularly well suited to mitigating climate change in health care systems because their existing role is central to patient care, and as a result they interface with other health care providers and have developed proficiency in articulation work

Study Protocol: Cannabis in the Closet? Older Persons' Perceptions of Stigma and their Influence on Use and Access to Medicinal Cannabis

Background: Cannabis has been used for medicinal purposes for millennia. Stigma associated with cannabis use may influence older persons access to cannabis, information seeking about cannabis, and/or use of cannabis. Scant research has sought to examine the impact of older persons’ perceptions of stigma on the ways they learn about and use medicinal cannabis, with important implications for their health. Methods/Design: In this qualitative descriptive study, we will seek older persons’ information needs and challenges accessing cannabis from older persons and professionals who work in the cannabis industry. Using open ended questions, we will survey and interview older persons who use cannabis or are considering using it about their perceptions of stigma, information seeking, choice of cannabis product, and preferred vendor. Professionals who work with cannabis will be interviewed for their experiences with older persons seeking information about and access to cannabis. Discussion: Findings will identify what information related to medicinal cannabis use older Canadians most urgently need, shed light on any stigma they fear and/or experience when searching for such information, and inform the development of information products and knowledge mobilization strategies tailored to older Canadians’ knowledge needs.&nbsp

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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