Helping New Jersey State Agencies and Departments Align Their Actions with GHG Reduction Mandates and Environmental Justice Principles

This white paper analyzes New Jersey’s implementation gap in both the climate and justice space. Its findings are potentially applicable to the many other states who have set climate and justice goals, without robustly embedding them into their existing legal and administrative landscapes. New Jersey already has GHG reduction targets, a plan, and mapped pathways. While more aggressive tactics and targets may be required to meet evolving scientific knowledge, and cost-effective technology and markets will evolve over time, New Jersey’s climate-alignment tools and pathways are clear. The EMP, the 2020 GWRA 80x50 Report, and EO-274, among other strong state initiatives, together demonstrate unequivocally that enacting an all agency, systematic approach to GHG reductions is essential. Likewise, New Jersey already has done the work to “Further the Promise” of environmental justice. Enacting an all agency, systematic approach to addressing past inequities and ensuring current operations are consistent with environmental justice principles will ensure that this effort yields legally durable results. This paper suggests legislative amendments that will spur expedited, equitable, climate aligned state action

Environmental Ethics and Environmental Law

This Note poses the question of whether—and how—lawmaking can create a platform for promoting an environmental ethic. There is a body of scholarship about how values or virtue ethics impact lawmaking, but this Note also explores the opposite—how lawmaking impacts the values or virtue ethics of the public. Environmental ethicists disagree about the very origins of environmental ethics. Some thinkers believe that environmental ethics stem from “core values” that are inherent to human nature. Others posit a set of “green virtues” that can be learned. But there is agreement that education through exposure to the natural world is fundamental to ethical development. Ideally, people develop green virtues that guide their everyday actions but, to encourage a true love of the natural world, their core values must be awakened; this is done locally, via connections to wild spaces. Through the creation of national parks and through public land-granting, law creates a platform that can contribute to the formation of environmental consciousness, from materializing the “wilderness” ideal to demonstrating the value of “otherness.” The relationship between environmental law and environmental ethics creates a virtuous circle—in both senses of the word—as virtue drives enriched environmental law as much as environmental law has the capacity to create green virtues. The virtuous circle concept risks the implied instrumentalization of virtues, robbing them of intrinsic realization by using them as policy tools. However, this is a false dichotomy; environmental law is a tool that can be used by a democracy to change itself by creating a different set of experiences to make concrete the values that we hold in abstraction or as aspiration. This Note draws on Aristotle’s virtue ethics to posit that lawmaking can create a holistic platform for people to learn how to practice an environmental ethic, which in turn promotes the passage of new regulatory and protective environmental laws

Adaptation of communication assessment tool for community pharmacists in medication adherence and minor diseases management

Aim: To develop two versions of the Communication Assessment Tool (CAT) skilled for the setting of community pharmacy and to pilot test it on a selected sample. Materials: Development of two versions of CAT-tool for community pharmacists. Validity and reliability assessments were required to determine the psychometric properties of developed tool versions. To investigate the construct validity of each adapted tool item, confirmatory factor analysis was performed. Reliability was assessed with the Cronbach’s Alpha evaluation, internal validity by submitting tool versions to patients of eleven pharmacies from North, Center, and South of Italy for pilot testing. Results: Two CAT versions were developed and tested: CAT-Pharm-community Adherence to therapy and Minor Disease Management versions. First to evaluate pharmacist-patient communication following the dispensing of a prescription drug, second a consultation for minor disease management. Conclusion: Communication tools are useful to implement optimal management of chronic diseases to minimize non-adherence and patients’ negative health outcomes

An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: The role of written and spoken communication

We tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing

Offering patients choices: A pilot study of interactions in the seizure clinic

Using conversation analysis (CA), we studied conversations between one United Kingdom-based epilepsy specialist and 13 patients with seizures in whom there was uncertainty about the diagnosis and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five, a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g., to address patient resistance). Close linguistic and, interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician dominated. (C) 2010 Elsevier Inc. All rights reserved

Italian translation and cultural adaptation of the communication assessment tool in an outpatient surgical clinic

The aim of the study is to translate and cross-culturally adapt, for use in the Italian context, the Communication Assessment Tool (CAT) developed by Makoul and colleagues

Assessment of surgeon communication skills from the patient perspective: A national evaluation using the Communication Assessment Tool

Objective: The Communication Assessment Tool (CAT) has previously been translated and adapted to the Italian context. This national study aimed to validate the CAT and evaluate communication skills of practicing surgeons from the patient perspective. Methods: CAT consists of 14 items associated with a 5-point scale (5 = excellent); results are reported as the percent of ‘‘excellent’’ scores. It was administered to 920 consenting outpatients aged 18–84 in 26 Italian surgical departments. Results: The largest age group was 45–64 (43.8%); 52.2% of the sample was male. Scores ranged from 44.6% to 66.6% excellent. The highest-scoring items were “Treated me with respect” (66.6%), “Gave me as much information as I wanted” (66.3%) and “Talked in terms I could understand” (66.0%); the lowest was “Encouraged me to ask questions” (44.6%). Significant differences were associated with age (18–24 year old patients exhibited the lowest scores) and geographical location (Northern Italy had the highest scores). Conclusion: CAT is a valid tool for measuring communication in surgical settings. Practice Implications: Results suggest that expectations of young people for communication in surgical settings are not being met. While there is room to improve communication skills of surgeons across Italy, patients highlighted the greatest need in the Central and Southern regions

Developing and piloting a communication assessment tool assessing patient perspectives on communication with pharmacists (CAT-Pharm)

Background: Effective communication strategies in health care help to enhance patient empowerment and improve clinical outcomes. Objective: Adapt the original Communication Assessment (CAT) instrument for the pharmacist profession (CAT-Pharm) and to test its validity and reliability in two different settings. Setting: Five hospital pharmacies in Italy and five community pharmacies in Malta. Method: Pilot study involving a standardized multi-step process adhering to internationally accepted and recommended guidelines. Corrections and adjustments to the translation addressed linguistic factors and cultural components. CAT-Pharm, compared to the original CAT, maintained 10 out of the 14 items: one was slightly modified; three were changed to better fit the pharmacist role; one was added. Main outcome measure: CAT-Pharm development and testing its practicality to Assess patient perceptions of pharmacists’ interpersonal and communication skills. Results CAT-Pharm was tested on 97 patients in the Italian setting and 150 patients in the Maltese setting to assess the practicality of the tool and its usefulness in investigating gaps and priorities for improving pharmacist-patient communication. Results: Show reliability and internal validity of the CAT-Pharm tool. The analysis of patient perceptions of communication with the pharmacist in Italy indicated differences from that in Malta. The different settings provided insight into the utility of CAT-Pharm. Conclusion: This study provided a valid and reliable tool that could be applied to assess patient perception of the pharmacist's communication abilities

Being as Normal as Possible: How Young People Ages 16–25 Years Evaluate the Risks and Benefits of Treatment for Inflammatory Arthritis

Objective To explore how young people (ages 16–25 years) with inflammatory arthritis evaluate the risks and benefits of treatment, particularly treatment with biologic therapies. Methods This qualitative study involved in-depth interviews (n = 44) with young people, trusted others (e.g., parents), and health professionals; audio-recordings (n = 4) of biologic therapy–related consultations; and focus groups (n = 4). Analysis used techniques from grounded theory (open and focused coding, constant comparison, memoing, and mapping). Results Young people aspired to live what they perceived as a “normal” life. They saw treatment as presenting both an opportunity for and a threat to achieving this. Treatment changes were therefore subject to complex and ongoing evaluation, covering administration, associated restrictions, anticipated effects, and side effects. Information sources included expert opinion (of professionals and other patients) and personal experience. Previous treatments provided important reference points. Faced with uncertain outcomes, young people made provisional decisions. Both trusted others and health professionals expressed concern that young people were too focused on short-term outcomes. Conclusion Young people value treatment that helps them to live a “normal” life. There is more to this than controlling disease. The emotional, social, and vocational consequences of treatment can be profound and lasting: opportunities to discuss the effects of treatment should be provided early and regularly. While making every effort to ensure understanding of the long-term clinical consequences of taking or not taking medication, the wider impact of treatment should not be dismissed. Only through understanding young people's values, preferences, and concerns can a sustainable balance between disease control and treatment burden be achieved