When Patients Ask to Die: The Role of Nurses in Medical Assistance in Dying

Canadians are increasingly living with chronic illness heightening the importance of palliative and end of life care. Nurses have significant involvement in end of life care which, in Canada, may now include medical assistance in dying (MAiD). This qualitative study used interpretive description to explore the perspectives of nine palliative care nurses regarding best practices in care related to MAiD. The analysis produced three overarching themes of: (a) Business as usual which reflects participants’ perspective that MAiD is an aspect of existing practices in end of life decision making in palliative care; (b) Nursing role within MAiD discusses the importance of patient centred care and includes assessment, liaison, intervention and bereavement; and (c) Support for Nurses to Provide MAiD Care reflecting the support required for nurses providing this care and includes (a) palliative education required, (b) conscientious objection to MAiD, and (c) give and take of the final intervention. The concept patient directed death is introduced in response to these findings, and aligns MAiD within existing patient centred end of life care. The findings from this study can inform nursing best practices related to MAiD in order to support quality end of life care

Acceptability and feasibility of using contingency management for cannabis reduction in specialist mental health services for psychosis: A qualitative study of staff views

AIM: There is increasing evidence linking cannabis use to onset, continuation, and relapse of psychosis. Contingency Management (CM) is discussed as a candidate intervention to reduce cannabis use. Our study aimed to explore staff views on the feasibility and acceptability of using CM for cannabis reduction in early intervention services for psychosis (EIS), in order to inform wider learning about implementation of such approaches in mental health services. SETTING: EIS teams in England. METHOD: Semi-structured interviews and focus groups analysed thematically. PARTICIPANTS: Forty managers and staff members working in mental health services where a CM intervention was delivered as part of a trial, four staff who delivered CM in these settings, and three key informants (academic experts in relevant fields). INTERVENTION: A complex intervention comprising CM with incremental financial incentives (vouchers) for reducing or stopping cannabis use, and psychoeducation about the risks of cannabis use. FINDINGS: Acceptability appeared to depend on how well the intervention was seen to fit with the service setting and ethos. Concerns included who should deliver CM; potential impacts on the therapeutic relationship; the ethics of using incentives to reduce socially objectionable behaviours; and how CM fits with the work of mental health practitioners. Feasibility concerns centred on resource limitations including time, cost, training, and national guidance and commissioning. CONCLUSIONS: Staff attitudes are likely to be a crucial influence on successful implementation of contingency management for cannabis reduction in specialist mental health settings. Several contextual barriers would need to be overcome to increase the acceptability of the intervention for use in early intervention services for psychosis

Implementing an Effective Community-Based Advisory Board (CAB) at New Haven Farms

New Haven has the second highest poverty and food insecurity rate in Connecticut. New Haven Farms (NHF) has been operating in the New Haven area since 2012, with a mission of using health promotion and community development programs to combat obesity, diabetes, and other diet-related diseases. NHF hopes to re-establish a community advisory board (CAB) to integrate community members into the organization to inform program development and strategy. The objectives of this study were as follows: Describe best practices for building an effective CAB within a community-based nonprofit organization, make relevant recommendations for restructuring the CAB, make recommendations for using community based best practices within a nonprofit.https://elischolar.library.yale.edu/ysph_pbchrr/1020/thumbnail.jp

Active Referral Intervention following Fragility Fractures Leads to Enhanced Osteoporosis Follow-Up Care

At one major urban academic medical center, patients aged 50 years and older with fragility fractures were identified and scheduled or assisted in referral into osteoporosis medical management appointments. We evaluated the efficacy of an active intervention program at overcoming the logistical barriers and improving proper osteoporosis follow-up for persons who have sustained a fragility fracture. Of 681 patients treated for defined fractures, 168 were eligible and consented for the study of fragility fractures. Of those enrolled, 91 (54.2%) had appropriate osteoporosis follow-up on initial interview, and overall 120 (71.4%) had successful osteoporosis follow-up following our active intervention. Seventy patients (41.7%) were deemed to have no osteoporosis follow-up, and, of these, 48 were successfully referred to a scheduling coordinator. The scheduling coordinator was able to contact 37 (77%) patients to schedule proper follow-up, and, of these, 29 (78.4%) confirmed receiving an appropriate follow-up appointment. Active intervention and assisted scheduling for patients with recent fragility fractures improved the self-reported rate of osteoporosis follow-up from 54.2% to 71.4%

Eucalyptus cinerea and E. nicholii by-Products as Source of Bioactive Compounds for Agricultural Applications

The cultivation of different species of Eucalyptus has recently expanded in Liguria (Italy) due to the growing demand of the North European floricultural market. Eucalyptus tree branches are cut and selected for their quality, resulting in large amounts of waste biomass to be disposed of. The aim of our study was to evaluate the phytotoxic and antimicrobial activities of essential oils (EOs) from pruning wastes of E. cinerea (EC) and E. nicholii (EN), for potential applications in agriculture. Phytochemical analyses showed eucalyptol (1,8-cineole) as the major component in both EOs, but the EO yield of EN was higher than that of EC, in agreement with a significantly higher oil gland density on EN leaves. EOs from both species showed phytotoxicity on both weeds tested, but no significant inhibition on horticultural crop seed germination, except for Raphanus sativus. The EO from EC showed the strongest antibacterial activity, while the EO from EN showed the strongest antifungal activity. Concluding, EOs from Eucalyptus pruning may be used as possible alternatives to synthetic herbicides and pesticides, acting as antimicrobial and antifungal agents, thus representing a safe strategy for crop management programs